PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY USING THE PARKLAND GRADING: AN OBSERVATIONAL STUDY IN A TERTIARY CENTER IN EASTERN UTTAR PRADESH, INDIA. singhmukul3911@gmail.com

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PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY USING THE PARKLAND GRADING: AN OBSERVATIONAL STUDY IN A TERTIARY CENTER IN EASTERN UTTAR PRADESH, INDIA.

2

India

Oral only

Laparoscopic cholecystectomy is the gold standard for treating symptomatic gallstones, but surgical difficulty can vary. This study aimed to identify if intra-operative factors could predict a difficult procedure by giving them an objective intra-operative Parkland grading scale.

This prospective observational study involved 44 patients undergoing laparoscopic cholecystectomy. Pre-operative demographic, clinical, and radiological data were collected. During surgery, the difficulty was assessed using the five-point Parkland grading scale. These findings were then analysed against operative time, post-operative stay, and conversion rates. The chi-squared test was used to determine the statistical significance of these associations.

A higher Parkland grade strongly correlated with increased surgical difficulty. Key intra-operative findings showed a significant association with higher grades: adhesions (p=0.0083), an impacted stone (p=0.0100), hyperemia (p=0.0477), and pericholecystic fluid (p=0.0228). Higher grades were directly linked to longer operative times and an increased risk of conversion to open surgery. Notably, the single case converted to an open procedure and two abandoned procedures were all classified as Parkland grade 5. Pre-operative factors such as BMI and a history of previous surgery did not show a significant correlation in this cohort.

The Parkland grading scale is a reliable measure of intra-operative difficulty in laparoscopic cholecystectomy. The presence of adhesions, impacted stones, and signs of acute inflammation are significant predictors of a more complex and prolonged surgery, highlighting their importance in pre-operative risk assessment.