Intra-Operative Assessment Of Laparoscopic Cholecystectomy

ABSTRACT

Gallbladder-related disease is now one of the commonest indications for elective and emergency surgery. Management of cholecystitis and its complications has evolved dramatically.1There have been significant paradigm shifts in the management of patients since the introduction of laparoscopic cholecystectomy in the mid1990s.2Laparoscopic cholecystectomy is the current gold standard for the treatment of symptomatic cholelithiasis.3But the severity of cholecystitis may be different in every patient and performing laparoscopic cholecystectomy may be difficult accordingly. Conversion from laparoscopic to open cholecystectomy is the essential part of the safe surgical practice if the anatomy is unclear, if complications arise, or if there is failure to make reasonable progress in a timely manner.4 Recently the importance of index admission laparoscopic cholecystectomy has been highlighted.5 In many large series and meta analyses detailed patient demographics and imaging findings have been recorded. A number of international guidelines recommend pathways of care.Attempts have been made to standardize definitions particularly relating to cholecystitis6,7.Despite these advances, significant variability in approaches to care and outcomes in gall-bladder disease management are reported.8While a number of preoperative scoring systems are reported there is no operative classification of findings at laparoscopic surgery.9,10.This limits the ability to compare outcomes or provide a common benchmark for future research. This prospective study was aimed to assess and grade the degree of difficulty in laparoscopic cholecystectomy and their postoperative outcome using intraoperative scoring system devised by Sugrue M et al.