A proposed inflammation grading system for laparoscopic cholecystectomy

Abstract

Background/aims: Currently, there is no comprehensive method to classify the inflammatory status of the GB and Calot's triangle.

Methodology: From 1996, we performed LC on 111 patients with symptomatic gallbladder diseases, irrespective of onset, using an abdominal wall-lifting method. Thirty-six patients had acute cholecystitis, while thirty had chronic cholecystitis. Severe inflammation prompted the author to design a grading system to record inflammatory status and to evaluate the feasibility of LC prospectively. GB with none - mild, moderate, severe wall thickening, and Calot's triangle involvement with mild - moderate, and severe inflammation were classified as Grade I - V, respectively.

Results: Forty-six cases had severe inflammation greater than grade III, however, neither CBD injury nor mortality was experienced. Complications were minimal. Of ten conversion cases (9.0%), eight were grade V, one grade III, and one grade I. Poor laparoscopic view caused by incomplete muscle relaxation accounted for four of the conversions.

Conclusions: Our grading system is useful in evaluating feasibility of difficult gallbladders, helping to decide conversion during LC, and as a tool to record or elucidate the chronological inflammatory changes of various GB disorders.