Pre-Operative Scoring to Anticipate Intraoperative Difficulty of Elective Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.51985/JBUMDC2025718Keywords:
Body Mass Index; Cholecystectomy, Laparoscopic; Risk Assessment; Sensitivity and Specificity; UltrasonographyAbstract
Objective: To evaluate the diagnostic accuracy of the Nassar preoperative scoring system in predicting intraoperative
difficulty in elective laparoscopic cholecystectomy, using the intraoperative Sugrue score as the reference standard.
Study Design and Setting: A prospective validation study conducted in the Department of Surgery, Khyber Teaching
Hospital, Peshawar.
Methodology: A total of 274 patients aged 20–60 years scheduled for elective laparoscopic cholecystectomy were enrolled
over six months. Exclusion criteria included prior hepatobiliary surgery, peritonitis, and cholangitis. Preoperative difficulty
was assessed using the Nassar scoring system based on clinical and ultrasound findings. Intraoperative difficulty was
assessed using the Sugrue scoring system. A Nassar score >6 predicted difficulty. Sensitivity, specificity, positive predictive
value (PPV), and negative predictive value (NPV) were calculated.
Results: Difficult laparoscopic cholecystectomy (Sugrue score >4) was observed in 16.1% of patients. The Nassar score
showed 84.1% sensitivity, 85.6% specificity, 52.9% PPV, and 96.6% NPV. Stratified analysis showed that age >40 years
(p=0.008), male gender (p=0.018), and BMI =30 kg/m² (p=0.032) were significantly associated with increased difficulty.
Conclusion: The Nassar preoperative scoring system is a reliable and clinically useful tool for predicting intraoperative
difficulty in elective laparoscopic cholecystectomy. Its high sensitivity and NPV make it particularly valuable in ruling
out difficult cases, facilitating better surgical planning and resource allocation in resource-limited settings
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Copyright (c) 2026 Ahmad Yar, Syed Asad Maroof, Muhammad Zarin, Kausar Noor, Muhammad Mazher Irshad, Sheema Gul (Author)
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