Predictive value of an intraoperative gallbladder scoring system for surgical difficulty and post-operative outcomes in laparoscopic cholecystectomy.

Abstract

Objective: Laparoscopic cholecystectomy (LC) is the gold standard surgical treatment for gallbladder diseases. This study aimed to evaluate the effectiveness of an intraoperative gallbladder scoring system in predicting surgical difficulty and perioperative outcomes in patients undergoing LC.

Methods: A total of 798 patients who underwent elective LC for cholecystopathy (symptomatic cholelithiasis, gallbladder polyps, and adenomyomatosis) performed by a single surgeon at our institution between March 2019 and February 2024 were retrospectively analyzed. Demographic characteristics, American Society of Anesthesiologists scores, and predisposing factors were recorded. The degree of intraoperative gallbladder adhesions was graded on a scale from 0 to 4 operative time, drain usage, conversion to open surgery, and post-operative complications were evaluated. The relationship between the intraoperative gallbladder score and surgical outcomes was statistically analyzed.

Results: The mean age of the patients was 51 years, and 61% were female. The intraoperative gallbladder score was 1 in 45.9% of patients, 2 in 26.3%, 3 in 15.1%, and 4 in 10.5%. Drain placement was required in 33.1% of cases. The conversion rate to open surgery was 2.1%. The post-operative complication rate was 1.1%. A statistically significant association was found between increasing intraoperative gallbladder scores and drain usage, post-operative complications, and conversion to open surgery (p<0.05). No significant association was observed between the intraoperative score and the need for endoscopic retrograde cholangiopancreatography.

Conclusion: The intraoperative gallbladder scoring system is a reliable and practical method for predicting surgical difficulty and adverse perioperative outcomes in LC. Its routine use may support surgical decision-making and improve patient safety and surgical outcomes.