Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Michael Sugrue, Federico Coccolini, Magda Bucholc, Alison Johnston, Dimitrios Manatakis, Orestis Ioannidis, Stefano Bonilauri, Mahir Gachabayov, Arda Isik, Wagih Ghnnam, Vishal Shelat, Muyiwa Aremu, Rajashekar Mohan, Giulia Montori, Maciej Waledziak, Magdalena Pisarska, Victor Kong, Marcin Strzalka, Paola Fugazzola, Gabriela Elisa NitaMatteo Nardi, Piotr Major, Ionut Negoi, Andrea Allegri, Georgios Konstantoudakis, Isidoro Di Carlo, Damien Massalou, Giuseppe D'Amico, Leonardo Solaini, Marco Ceresoli, Roberto Bini, Martin Zielinski, Matteo Tomasoni, Andrey Litvin, Belinda De Simone, Eftychios Lostoridis, Fernando Hernandez, Gabor Panyor, Gustavo M., V Machain, Ioanna Pentara, Luca Baiocchi, Kin Cheung Ng, Luca Ansaloni, Massimo Sartelli, Miguel Leon Arellano, Natalia Savala, Neville Couse, Sarah McBride

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Introduction: Laparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy.
Methods: A prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded.
Results: Five hundred four patients, mean age 53.5 (range 18-89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. (p < 0.0001; AUC 0.772 (CI 0.719-0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance - completely buried GB, impacted stone, bile or pus outside GB and fistula.
Conclusion: The G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy.

Original languageEnglish
Article number12
Pages (from-to)1-8
Number of pages8
JournalWorld Journal of Emergency Surgery
Issue number1
Early online date14 Mar 2019
Publication statusPublished online - 14 Mar 2019


  • Cholecystitis
  • Surgical outcomes
  • Operative severity scoring system
  • Conversion to open cholecystectomy
  • Index surgery
  • Emergency surgery
  • Cholecystectomy
  • Laparoscopic cholecystectomy


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