Soltes and Radonak developed a score for predicting the difficulty of performing an elective laparoscopic cholecystectomy. This can help to identify a patient who may require an open procedure. The authors are from the University of Pavol Jozef Safarik in the Slovak Republic.
Patient selection: cholecystectomy
Parameters:
(1) gender
(2) history of biliary colic within past 3 weeks
(3) history of acute cholecystitis
(4) history of previous upper abdominal surgery
(5) right upper quadrant pain
(6) rigidity over the right upper quadrant
(7) thickness of the gallbladder wall in mm
(8) diameter of the gallbladder in cm
(9) shrunken gallbladder
|
Parameter
|
Finding
|
Points
|
|
gender
|
female
|
0
|
|
|
male
|
1
|
|
history of biliary colic
|
no
|
0
|
|
|
yes
|
1
|
|
history of acute cholecystitis
|
no
|
0
|
|
|
yes
|
1
|
|
previous upper abdominal surgery
|
no
|
0
|
|
|
yes
|
2
|
|
right upper quadrant pain
|
no
|
0
|
|
|
yes
|
1
|
|
rigidity of right upper quadrant
|
no
|
0
|
|
|
yes
|
1
|
|
gallbladder wall
|
< 4 mm
|
0
|
|
|
>= 4 mm
|
1
|
|
diameter of the gallbladder
|
<= 4.5 cm
|
0
|
|
|
> 4.5 cm (hydropic)
|
1
|
|
shrunken gallbladder
|
no
|
0
|
|
|
yes
|
1
|
where:
• A shrunken and hydropic gallbladder are mutually exclusive.
total score =
= SUM(points for all 9 parameters)
estimated operating time in minutes =
= (19.28 * (score)) + 42.19
Interpretation:
• minimum score: 0
• maximum score: 9 (if shrunken and hydropic mutually exclusive)
• The higher the score the greater the difficulty in performing a laparoscopic cholecystectomy.
|
Score
|
Difficulty
|
Percent Converted
|
|
0
|
easy
|
0
|
|
1
|
minor problems
|
0.5%
|
|
2
|
difficult
|
5.5%
|
|
3
|
very difficult
|
16.7%
|
|
>= 4
|
conversion
|
100%
|
