Abstract
IntroductionVariation in outcomes from surgery is a major challenge and defining surgical findings may help set benchmarks, which currently do not exist in laparoscopic cholecystectomy. This study outlines a new surgical scoring system incorporating key operative findings.MethodsEnglish language studies (from January 1965 to July 2014) pertaining to severity scoring and predictors of difficult laparoscopic cholecystectomy were searched for in PubMed, Embase and Cochrane databases using the search terms ‘Laparoscopic cholecystectomy or Lap chole’ and/or ‘Scoring Index or Grading system or Prediction of difficulty or Conversion to open’ in various combinations. Cross-referencing from papers retrieved in the original search identified additional articles.ResultsSixteen published papers report a gallbladder (GB) scoring system, but all relate to pre-operative clinical and imaging findings, rather than operative findings. The current scoring system, using operative findings incorporates the appearance of the GB, presence of GB distension, ease of access, potential biliary complications and time taken to identify cystic duct and artery. A score of <2 would imply mild difficulty, 2–4 moderate, 5–7 severe and 8–10 extreme.ConclusionThis paper reports one of the first operative classifications of findings at laparoscopic cholecystectomy. It has the potential to allow benchmarks for international collaboration of operative and patient outcomes in patients undergoing laparoscopic cholecystectomy.
Highlights
Variation in outcomes from surgery is a major challenge and defining surgical findings may help set benchmarks, which currently do not exist in laparoscopic cholecystectomy
A literature review was undertaken of PubMed, Embase and Cochrane databases between January 1965 and July 2014 for publications relating to difficulty prediction in laparoscopic cholecystectomy using the search terms
In total 16 papers were found relating to difficulty prediction in laparoscopic cholecystectomy
Summary
Variation in outcomes from surgery is a major challenge and defining surgical findings may help set benchmarks, which currently do not exist in laparoscopic cholecystectomy. This study outlines a new surgical scoring system incorporating key operative findings. Understanding outcomes is key to advancing health care, and while conversion to open cholecystectomy will always be Despite these advances, significant variability in approaches to care and outcomes in gall-bladder disease management are reported [7]. While a number of preoperative scoring systems are reported there is no operative classification of findings at laparoscopic surgery [8,9]. This limits the ability to compare outcomes or provide a common benchmark for future research. This paper outlines a new scoring system for operative findings at laparoscopic cholecystectomy, to allow grading of the findings and standardize the degree of cholecystitis
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