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The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation

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Published on: January 31, 2025

Preoperative Conversion Risk Score for Acute Calculous Cholecystitis: Does TG18 Add Value?

Rahman Şenocak¹, Murat Özkara², Şahin Kaymak¹

¹Department of General Surgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Türkiye.

The Journal of Surgical Research

|July 8, 2026

Summary

This summary is machine-generated.

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Cholecystitis

Cholecystitis

Cholecystitis is inflammation of the gallbladder, most commonly caused by obstruction of the cystic duct. This blockage prevents bile from draining, leading to gallbladder distension, inflammation, and potentially serious complications. This condition may present acutely or chronically and can happen with or without gallstones.EtiologyAbout 95% of cholecystitis cases are calculous, caused by gallstones blocking the cystic duct, leading to bile accumulation and inflammation of the gallbladder...

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A new preoperative score accurately predicts conversion risk for acute calculous cholecystitis, outperforming the Tokyo Guidelines. This tool aids surgeons in planning laparoscopic cholecystectomy by identifying patients needing open conversion.

Area of Science:

Surgical Oncology
Gastroenterology
Medical Decision Making

Background:

The 2018 Tokyo Guidelines (TG18) are standard for acute calculous cholecystitis but lack predictive value for laparoscopic to open cholecystectomy conversion.
Individualized preoperative risk assessment is crucial for surgical planning and patient outcomes.

Purpose of the Study:

To develop and validate a practical preoperative model and point-based score for predicting conversion risk.
To compare the predictive performance of the new score against TG18 alone.

Main Methods:

A retrospective cohort study of 183 patients undergoing laparoscopic cholecystectomy for acute calculous cholecystitis.
Multivariable Firth penalized logistic regression identified predictors: age, diabetes mellitus, WBC, LDH, and gallbladder wall thickness.

Keywords:

Acute calculous cholecystitis Conversion risk score Conversion to open surgery Laparoscopic cholecystectomy Preoperative risk model Tokyo guidelines 2018

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A point-based conversion risk score was derived from the final model.

Main Results:

Conversion occurred in 18.0% of patients.
The developed clinical and hybrid models demonstrated high discrimination (AUC 0.927-0.931).
The derived score showed good discrimination (AUC 0.893), outperforming TG18 (AUC 0.576) and not significantly improved by its addition.

Conclusions:

A simple preoperative score using age, diabetes, WBC, LDH, and gallbladder wall thickness offers superior patient-level prediction for conversion risk.
TG18 is more useful for interpreting within-grade heterogeneity than for global discrimination of conversion risk.