Development of a predictive scoring system for identifying difficult laparoscopic cholecystectomy cases based on preoperative factors

Sarvagya Chirag Jha; Hemang Ashokbhai Panchal

doi:10.18203/2349-2902.isj20251173

Authors

Sarvagya Chirag Jha Department of Surgery, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, India
Hemang Ashokbhai Panchal Department of Surgery, GMERS Medical College and Hospital, Sola, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20251173

Keywords:

Predictive scoring system, Laparoscopic cholecystectomy, Gallstone disease, Surgical outcomes, Risk stratification, Preoperative planning

Abstract

Background: Laparoscopic cholecystectomy (LC) is the preferred treatment for gallstone disease. However, difficult cases often require conversion to open surgery and are associated with higher complications. A standardized scoring system can aid in predicting difficult LC cases, enabling better preoperative planning and patient counseling. This study aims to develop and validate a scoring system based on key preoperative factors to predict difficult LC cases.

Methods: This prospective study was conducted at a tertiary healthcare center in India, analyzing 80 patients who underwent LC. Based on previously identified risk factors-including patient-related, biochemical, imaging, and intraoperative variables-a scoring system was developed. Each factor was assigned a weighted score based on its impact on surgical difficulty. The scoring model was validated by assessing correlation with surgical outcomes.

Results: Patients were stratified into three risk categories: low (<5 points), moderate (5-9 points), and high (≥10 points). Among patients with high scores, 80% required conversion to open surgery, 60% developed postoperative complications, and their hospital stay was significantly prolonged (p<0.05). In contrast, low-score patients had no conversions and minimal complications. The scoring system demonstrated strong predictive capability (AUC=0.87, p<0.001).

Conclusions: This predictive scoring system effectively identifies difficult LC cases. Its application can optimize surgical planning, minimize adverse outcomes, and improve patient selection for early open surgery.

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