Utility of the Parkland Grading Scale to determine intraoperative challenges during laparoscopic cholecystectomy: a validation study on 206 patients at an academic medical center in Nepal

• Published in: Patient safety in surgery 2023-05, Vol.17 (1), p.12-12, Article 12
• Main Authors: Shrestha, Anup, Bhattarai, Abhishek, Tamrakar, Kishor Kumar, Chand, Manoj, Yonjan Tamang, Samjhana, Adhikari, Sampada, Neupane, Harish Chandra
• Format: Article
• Language: English
• Subjects: Abdominal surgery; Analysis; Bile ducts; Body mass; Body mass index; Body size; Cholecystectomy; Cholecystitis; Conversion; Decompression; Difficulty; Gallbladder; Gallbladder diseases; Gallstones; Health care facilities; Hospitals; Inflammation; Laparoscopic cholecystectomy; Laparoscopic surgery; Laparoscopy; Likert scale; Medical centers; Medical research; Medicine, Experimental; Mortality; Pancreatitis; Parkland Grading Scale; Parks; Patients; Pneumonia; Statistical analysis; Surgeons; Surgery; Utilization
• ISSN: 1754-9493; 1754-9493
• DOI: 10.1186/s13037-023-00364-x

Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy. This was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale. Out of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19-75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p