Comparison of two preoperative scoring systems in predicting difficult laparoscopic cholecystectomy

Abstract

Background: Gallstones are a prevalent condition in India, with laparoscopic cholecystectomy being the gold standard treatment. Accurate preoperative prediction of surgical difficulty is essential to improve outcomes and reduce complications. Methods: This prospective observational study, conducted among 77 patients at a tertiary care center, compared two scoring systems: Randhawa and Pujahari, Acharya and Adhikari. Preoperative scores were assessed using clinical, laboratory, and imaging parameters. These scores were compared to intraoperative outcomes such as surgery duration, complications, and conversion to open cholecystectomy. Results: Both scoring systems showed reliable accuracy in predicting surgical difficulty. Randhawa and Pujahari demonstrated higher specificity and better performance in ruling out difficult cases, while Acharya and Adhikari showed higher sensitivity and negative predictive value. Most surgeries were categorized as easy (66.2%), with a smaller proportion being difficult (31.2%) or very difficult (2.6%). Conclusions: Preoperative scoring systems are valuable tools for predicting the complexity of laparoscopic cholecystectomy. While both systems performed well, Randhawa and Pujahari had slightly better accuracy, whereas Acharya and Adhikari showed superior sensitivity.