Mezjda Ismail Rashaan a

a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 

Submitted: 28/8/2020; Accepted: 29/11/2020; Published: 21/6/2021

DOI Link: https://doi.org/10.17656/jsmc.10296 



Laparoscopic cholecystectomy (LC) is currently the gold standard procedure for management of gall bladder diseases (GBD). Bile duct injuries are the most disaster complication during this procedure, especially in patients with acute cholecystitis. To decrease such biliary injuries intraoperatively and conversion rates, it is necessary to have preoperative and intraoperative assessment of gall bladder according to special grading scale. In this study for such evaluation and assessment in patients with acute cholecystitis we are using Parkland Grading Scale (PGS).


To evaluate pre-operative findings, conversion rates, and perioperative complications of laparoscopic cholecystectomy through intra-operative assessment of the gallbladder during laparoscopic cholecystectomy.

Materials and Methods

A cohort of patients who underwent laparoscopic cholecystectomy were retrospectively studied. The Parkland Grading Scale for Cholecystitis (PGS), which consists of a five-tier grading system, was used for the intra-operative assessment of the gallbladder


710 patients who underwent laparoscopic cholecystectomy were included in this study. High pre-operative white blood cell counts, as well as bilirubin and alkaline phosphatase levels and ultrasonography features such as gallbladder thickness, bile duct dilatation, and stones in the common bile duct, were significantly more often present in patients with grades 3, 4, and 5 than in patients with grades 1 and 2 (p<0.0001). Patients with grades 4 and 5 had the highest conversion rate compared with patients with other grades (50.0% and 66.7%, respectively, p<0.0001). Furthermore, the number of perioperative complications was highest with grades 4 and 5 compared with other grades (40.0% and 33.3%, respectively, p<0.0001). The incidence of bile duct injuries, seroma, and wound infections were highest with grade 4 compared with other grades (5%, 10%, and 20%, respectively, p<0.0001) 


Intra-operative assessment of the severity of gallbladder disease using the Parkland Grading Scale for Cholecystitis (PGS) during laparoscopic cholecystectomy is a valuable tool to assess the difficultly of laparoscopic cholecystectomy, the conversion rates, and perioperative complications.


Intraoperative Scoring, Laparoscopic Cholecystectomy, Valuable Tool Perioperative Complications, Conversion Rates.


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