Clinical Implication of Intraoperative Gallbladder Scoring Predicting the Need for Conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy
DOI:
https://doi.org/10.51985/Keywords:
Laparoscopic cholecystectomy, open cholecystectomy, Nassar score, conversion, gallbladder scoringAbstract
Objective: To determine the association between intraoperative Nassar Difficulty Grade and conversion from laparoscopic to open cholecystectomy in adults undergoing laparoscopic cholecystectomy for benign gallbladder disease. Study Design & Setting: Prospective observational cohort study conducted in the Department of General Surgery, Pakistan Railways Hospital, Rawalpindi, from 9 February 2026 to 8 May 2026.
Methodology: Ninety-eight consecutive adults undergoing laparoscopic cholecystectomy for benign gallbladder disease were enrolled. Demographic, clinical, ultrasonographic, intraoperative and conversion data were recorded prospectively. Intraoperative difficulty was graded using the Nassar Difficulty Grading Scale. Grades I-II were categorized as low difficulty and Grades III-IV as high difficulty. Conversion proportions were compared using two-sided Fisher exact testing because of sparse cells, and a crude odds ratio (OR) with 95% confidence interval (CI) was calculated for high versus low Nassar grade. A p-value <0.05 was considered statistically significant.
Results: The mean age was 43.8 ± 13.2 years; 67/98 (68.4%) participants were female. Overall, 10/98 (10.2%) procedures were converted to open cholecystectomy. Conversion occurred in Grade I 1/34 (2.9%), Grade II 1/29 (3.4%), Grade III 3/21 (14.3%), and Grade IV 5/14 (35.7%). High difficulty (Grades III-IV) was associated with greater crude odds of conversion than low difficulty (Grades I-II): 8/35 (22.9%) versus 2/63 (3.2%); crude OR 9.04 (95% CI 1.80-45.41), Fisher exact p=0.004.
Conclusion: Higher intraoperative Nassar Difficulty Grade was associated with conversion to open cholecystectomy in this single-center observational cohort. The scale may support structured intraoperative assessment and communication, but the findings are unadjusted and should not be interpreted as evidence that Nassar grade independently predicts conversion
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