Yu-Chung Chang1. 1. Department of Surgery, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan. changmdphd@yahoo.com
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.
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.
Authors: Giuseppe Borzellino; Stefan Sauerland; Anna Maria Minicozzi; Giuseppe Verlato; Carlo Di Pietrantonj; Giovanni de Manzoni; Claudio Cordiano Journal: Surg Endosc Date: 2007-08-18 Impact factor: 4.584