Tarik D Madni1, David E Leshikar2, Christian T Minshall3, Paul A Nakonezny4, Canon C Cornelius5, Jonathan B Imran6, Audra T Clark7, Brian H Williams8, Alexander L Eastman9, Joseph P Minei10, Herb A Phelan11, Michael W Cripps12. 1. UT Southwestern Department of Surgery, Dallas, TX, United States. Electronic address: tarik.madni@utsouthwestern.edu. 2. UC Davis, Division of Trauma and Acute Care Surgery, Sacramento, CA, United States. Electronic address: deleshikar@ucdavis.edu. 3. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: christian.minshall@utsouthwestern.edu. 4. UT Southwestern Department of Clinical Sciences, Division of Biostatistics, Dallas, TX, United States. Electronic address: paul.nakonezny@utsouthwestern.edu. 5. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: Canon.C.Cornelius@uth.tmc.edu. 6. UT Southwestern Department of Surgery, Dallas, TX, United States. Electronic address: jonathan.imran@utsouthwestern.edu. 7. UT Southwestern Department of Surgery, Dallas, TX, United States. Electronic address: audra.clark@utsouthwestern.edu. 8. UT Southwestern Department of Surgery, Dallas, TX, United States. Electronic address: Brian.williams@utsouthwestern.edu. 9. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: alexander.eastman@utsouthwestern.edu. 10. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: joseph.minei@utsouthwestern.edu. 11. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: herb.phlelan@utsouthwestern.edu. 12. UT Southwestern Division of Burn/Trauma/Critical Care, Dallas, TX, United States. Electronic address: michael.cripps@utsouthwestern.edu.
Abstract
BACKGROUND: Gallbladders (GBs) with severe inflammation have longer operative times and an increased risk for complications. We propose a grading system using intraoperative images to better stratify GB inflammation. METHODS: After reviewing the intraoperative images of GBs obtained during several hundred laparoscopic cholecystectomies, we developed a five-tiered grading system based on anatomy and inflammatory changes. Fifty intraoperative photographs were taken prior to dissection and then distributed to 11 surgeons who rated each GB's severity per the grading system. The two-way random effects Intraclass Correlation Coefficient (ICC) was used to assess the reliability among the raters. RESULTS: The ICC among the raters of GB severity was 0.804 (95% CI: 0.733 to 0.867; p = 0.0001). Nineteen GB images had greater than 82% agreement and 16 were clustered around GBs with severe inflammation (grades 3-5). CONCLUSION: This study proposes a simple, reliable grading system that characterizes GB complexity based on inflammation and anatomy.
BACKGROUND: Gallbladders (GBs) with severe inflammation have longer operative times and an increased risk for complications. We propose a grading system using intraoperative images to better stratify GB inflammation. METHODS: After reviewing the intraoperative images of GBs obtained during several hundred laparoscopic cholecystectomies, we developed a five-tiered grading system based on anatomy and inflammatory changes. Fifty intraoperative photographs were taken prior to dissection and then distributed to 11 surgeons who rated each GB's severity per the grading system. The two-way random effects Intraclass Correlation Coefficient (ICC) was used to assess the reliability among the raters. RESULTS: The ICC among the raters of GB severity was 0.804 (95% CI: 0.733 to 0.867; p = 0.0001). Nineteen GB images had greater than 82% agreement and 16 were clustered around GBs with severe inflammation (grades 3-5). CONCLUSION: This study proposes a simple, reliable grading system that characterizes GB complexity based on inflammation and anatomy.
Authors: Ewen A Griffiths; James Hodson; Ravi S Vohra; Paul Marriott; Tarek Katbeh; Samer Zino; Ahmad H M Nassar Journal: Surg Endosc Date: 2018-06-28 Impact factor: 4.584
Authors: Yi Jin; Runwen Liu; Yonghua Chen; Jie Liu; Ying Zhao; Ailin Wei; Yichuan Li; Hai Li; Jun Xu; Xin Wang; Ang Li Journal: Front Surg Date: 2022-08-01