Validation of Pre and Per Operative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy

Pankaj Kumar Saunakiya; Alok Verma; Rajeev Sinha

doi:10.55489/njmr.160120261207

Authors

Pankaj Kumar Saunakiya Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, India
Alok Verma Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, India
Rajeev Sinha Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, India

DOI:

https://doi.org/10.55489/njmr.160120261207

Keywords:

Laparoscopic cholecystectomy, Predictive scoring system, Nassar scale, Surgical difficulty, Preoperative assessment

Abstract

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallbladder disease, but predicting intraoperative difficulty remains challenging. Preoperative and intraoperative scoring systems, such as the Nassar scale, aim to identify high-risk cases and improve surgical planning. The objective of this study is to validate preoperative and intraoperative scoring systems for predicting difficult laparoscopic cholecystectomy and to identify significant predictors associated with increased surgical complexity.

Methodology: This prospective observational study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from May 2023 to June 2024, including 166 LC patients meeting inclusion criteria. Preoperative factors (age, gender, ASA grade, gallbladder wall thickness, CBD diameter, admission type) were documented. Intraoperative difficulty was graded using the Nassar scale. Statistical analyses included chi-square tests and multivariate logistic regression (p<0.05).

Results: Difficult LC occurred in 36.7% of cases. Significant predictors on univariate analysis included age >50 years, male gender, higher ASA grade, thick gallbladder wall, and emergency admission. Multivariate analysis identified male gender and emergency admission as independent predictors. Higher Nassar grades (3-4) strongly correlated with increased difficulty, operative time, blood loss, and postoperative interventions.

Conclusions: Validated scoring systems reliably predict difficult LC, aiding preoperative counselling, surgical preparedness, and resource allocation. Their routine use can improve safety and outcomes.

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