Validation of Nassar Difficulty Grading Scale in Predicting Difficult Laparoscopic Cholecystectomy

Background: Cholelithiasis is a common disease & laparoscopic cholecystectomy is the gold standard treatment for cholecystitis. There is a need for a preoperative scoring system that can accurately predict difficult laparoscopic
cholecystectomies to assist in selection of patients as a day case surgery, to assign the procedure to a surgeon with
the appropriate experience and to counsel the patient throughout the consent process.
The aim of this study: To validate Nassar preoperative scoring system that would predict difficult laparoscopic cholecystectomies. conversion to open cholecystectomy was considered the primary end point of difficulty.
Patients and methods: This was a prospective cohort study to patients who underwent laparoscopic
cholecystectomies at our department of surgery, King Abdul-Aziz specialized hospital (KAASH) at Taif, Ministry of
health, Saudi Arabia between April 2020, and April 2022.
Results: 1357 patients underwent laparoscopic cholecystectomy whether elective or emergent. After admission of
patients to operative theatre for laparoscopic cholecystectomy, 478 (35.2%) of patients were converted to open to
complete the procedure. Patients & percentages of difficult operations were classified according to Nassar risk score
from 0 to 19 & then, subdividing all risk scores into 3 subgroups: low, medium & high-risk score. It was found that
56% of preoperative high-risk patients (7-19) had difficult operations, while 24.4% of medium-risk patients (2-6)
had difficult operations & only 10.1% of patients of Low-risk group had difficult procedures.
Conclusion: Nassar difficulty grading scale is considered straightforward, clinically & surgically applicable, and
easy to use preoperative scoring system to predict difficult laparoscopic cholecystectomies.