A proposed inflammation grading system for laparoscopic cholecystectomy

Area of Science:

• Surgical innovation
• Gastroenterology
• Medical imaging

Background:

• Laparoscopic cholecystectomy (LC) lacks a standardized method for classifying gallbladder (GB) and Calot's triangle inflammation.
• Inflammatory status significantly impacts surgical difficulty and outcomes in GB disease.

Purpose of the Study:

• To develop and validate a novel grading system for assessing GB and Calot's triangle inflammation.
• To evaluate the system's utility in predicting LC feasibility and guiding intraoperative decisions.

Main Methods:

• A grading system (Grade I-V) was developed based on GB wall thickening and Calot's triangle inflammation.
• The system was applied prospectively to 111 patients undergoing LC for symptomatic GB disease using an abdominal wall-lifting method.
• Data on inflammatory grade, operative findings, and complications were collected.

Main Results:

• Forty-six patients presented with severe inflammation (Grade III or higher).
• No common bile duct (CBD) injuries or mortality were observed.
• Conversions to open surgery (9.0%) were associated with higher inflammatory grades (e.g., Grade V).
• Incomplete muscle relaxation affected laparoscopic view in four conversion cases.

Conclusions:

• The proposed grading system effectively evaluates the feasibility of LC in difficult gallbladders.
• It serves as a valuable tool for intraoperative decision-making, particularly regarding conversion.
• The system aids in documenting and understanding inflammatory changes in various GB disorders.