A new preoperative grading system for predicting the operative conditions for abdominal wall-lifting laparoscopic cholecystectomy

Purpose. This study was performed to evaluate the operative conditions for an abdominal wall-lifting laparoscopic cholecystectomy (ALLC) using a new preoperative grading system. Methods. One hundred forty-five patients who underwent a cholecystectomy for cholecystolithiasis from January 1997 to December 1999 were retrospectively analyzed. Allotting 0-5 points for coexisting cholecystitis, past history, previous upper abdominal laparotomy, preoperative drainage, location of the stones, and body mass index, the total combined score was defined as the predictive score. The cases were graded into four risk groups according to the predictive score. The postoperative score, which evaluated the actual conditions of ALLC, was defined by allotting 0-8 points to operative factors: operation time, blood loss, additional trocars and procedures, conversion to open surgery, and postoperative complications. Results. Ten cases (6.9%) were converted to open surgery and three cases (2.1%) had minor postoperative complications. The conversion rate for each risk group was 0% (minimum risk group), 5.4% (low-risk group), 10.7% (intermediate-risk group), and 17.9% (high-risk group). The mean operation time was 63.0, 87.5, 89.0, and 120.2 min. The mean postoperative score was 1.08, 2.81, 3.96, and 6.36, and showed a respectively strong correlation with the predictive score (correlation coefficient: 0.997). Conclusions. Our preoperative grading system using the predictive score was found to be a reliable and feasible method for predicting the actual operative conditions for ALLC.