Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective
Introduction. Difficult geographic diversity and late presentation to medical attention often make the laparoscopic cholecystectomy difficult and chances of conversion and complication remains. Various preoperative grading scales have been developed for predicting the difficulty of surgery in cholec...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/8954572 |
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| author | Suman Baral Raj Kumar Chhetri Neeraj Thapa |
| author_facet | Suman Baral Raj Kumar Chhetri Neeraj Thapa |
| author_sort | Suman Baral |
| collection | DOAJ |
| description | Introduction. Difficult geographic diversity and late presentation to medical attention often make the laparoscopic cholecystectomy difficult and chances of conversion and complication remains. Various preoperative grading scales have been developed for predicting the difficulty of surgery in cholecystitis patients; however, intraoperative assessment of anatomical status and inflammation of the gall bladder has not been assessed till date except for some guidelines like the Parkland grading scale (PGS). We aimed to utilise this guideline in patients undergoing laparoscopic cholecystectomy in rural community of the developing nation. Methods. PGS was applied for all the patients undergoing laparoscopic cholecystectomy and laboratory and outcome factors like preoperative white blood cells (WBC), open conversion, subtotal cholecystectomy, length of surgery, and bile leaks postoperatively were assessed. Results. Among 178 patients who underwent cholecystectomy, there were 40 grade one GBs, 90 grade two GBs, 26 grade three GBs, 16 grade four GBs, and six grade five GBs. With a conversion rate of 6.74%, eight patients underwent subtotal cholecystectomy. Among them, four patients were graded as 5th grade, two as 4th grade, and two as 3rd grade according to PGS system. Postoperative bile leak was seen in three patients among which two were grade five GBs and one was grade four. Preoperative WBC, conversion to open, subtotal cholecystectomy, length of surgery, and postoperative bile leak all significantly increased with increasing grades (p<0.05). Conclusion. PGS can be applied in patients undergoing laparoscopic cholecystectomy in the rural setting of a developing nation. With its application, postoperative course could be predicted and adequate counselling can be done about the possibilities of the outcome. |
| format | Article |
| id | doaj-art-f51d2218aa274baca0f39f8887d03d11 |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
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| series | Gastroenterology Research and Practice |
| spelling | doaj-art-f51d2218aa274baca0f39f8887d03d112025-02-03T05:57:19ZengWileyGastroenterology Research and Practice1687-61211687-630X2020-01-01202010.1155/2020/89545728954572Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese PerspectiveSuman Baral0Raj Kumar Chhetri1Neeraj Thapa2Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Pravas, Tansen-7, Palpa, NepalDepartment of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Pravas, Tansen-7, Palpa, NepalDepartment of Surgery, Lumbini Medical College and Teaching Hospital Ltd., Pravas, Tansen-7, Palpa, NepalIntroduction. Difficult geographic diversity and late presentation to medical attention often make the laparoscopic cholecystectomy difficult and chances of conversion and complication remains. Various preoperative grading scales have been developed for predicting the difficulty of surgery in cholecystitis patients; however, intraoperative assessment of anatomical status and inflammation of the gall bladder has not been assessed till date except for some guidelines like the Parkland grading scale (PGS). We aimed to utilise this guideline in patients undergoing laparoscopic cholecystectomy in rural community of the developing nation. Methods. PGS was applied for all the patients undergoing laparoscopic cholecystectomy and laboratory and outcome factors like preoperative white blood cells (WBC), open conversion, subtotal cholecystectomy, length of surgery, and bile leaks postoperatively were assessed. Results. Among 178 patients who underwent cholecystectomy, there were 40 grade one GBs, 90 grade two GBs, 26 grade three GBs, 16 grade four GBs, and six grade five GBs. With a conversion rate of 6.74%, eight patients underwent subtotal cholecystectomy. Among them, four patients were graded as 5th grade, two as 4th grade, and two as 3rd grade according to PGS system. Postoperative bile leak was seen in three patients among which two were grade five GBs and one was grade four. Preoperative WBC, conversion to open, subtotal cholecystectomy, length of surgery, and postoperative bile leak all significantly increased with increasing grades (p<0.05). Conclusion. PGS can be applied in patients undergoing laparoscopic cholecystectomy in the rural setting of a developing nation. With its application, postoperative course could be predicted and adequate counselling can be done about the possibilities of the outcome.http://dx.doi.org/10.1155/2020/8954572 |
| spellingShingle | Suman Baral Raj Kumar Chhetri Neeraj Thapa Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective Gastroenterology Research and Practice |
| title | Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective |
| title_full | Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective |
| title_fullStr | Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective |
| title_full_unstemmed | Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective |
| title_short | Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective |
| title_sort | utilization of an intraoperative grading scale in laparoscopic cholecystectomy a nepalese perspective |
| url | http://dx.doi.org/10.1155/2020/8954572 |
| work_keys_str_mv | AT sumanbaral utilizationofanintraoperativegradingscaleinlaparoscopiccholecystectomyanepaleseperspective AT rajkumarchhetri utilizationofanintraoperativegradingscaleinlaparoscopiccholecystectomyanepaleseperspective AT neerajthapa utilizationofanintraoperativegradingscaleinlaparoscopiccholecystectomyanepaleseperspective |