The Nassar Scale as an Instrument for Predicting Conversionof Laparoscopic to Open Cholecystectomy

Abstract

Background: Difficult cholecystectomy, often associated with a heightened risk of complications, poses a significant surgical dilemma. Risk factors, such as patient age, increased body weight, the presence of gallstones, acute cholecystitis, and prior abdominal surgeries, can complicate laparoscopic cholecystectomy and necessitate conver- sion to an open procedure for safety. The aim of our study was to assess the applicability of the Nassar scale in predicting the need for conversion from laparoscopic to open cholecystectomy.Material and methods: In our prospective cohort study, we included 85 patients who underwent either emergency or elective laparoscopic cholecystectomy between December 2021 and October 2023. The Nassar scale was used to assess the complexity of laparoscopic cholecystectomy, incorporating parameters such as ‘Gallbladder,’ ‘Cystic pedicle,’and ‘Adhesions’ to determine a final score ranging from 1 to 5. Statistical analysis involved descriptive and analytical methods, with the significance threshold set at p < 0.05.Results: ANOVA analysis revealed a statistically significant difference in the duration of operative procedures with different Nassar grades (p < 0.001). An increase in the Nassar grade by 1 was associated with a statistically significant6.23-fold increase in the odds of conversion to an open procedure (p < 0.001). Receiver Operating Characteristic (ROC) analysis demonstrated a highly significant association (p < 0.001) between the Nassar grade and the conversion event, with an Area Under the Curve (AUC) of 0.881 (95% CI 0.79,0.96). The optimal cutoff value, identified as >2.5, struck a balance between sensitivity (0.86) and 1-specificity (0.23). Conclusion: Our study underscores the utility of the Nassar scale in surgical practice. It provides valuable insights into assessing the severity of operations, facilitating informed decision-making, and optimizing treatment outcomes for patients undergoing laparoscopic cholecystectomy at our institution.