{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:21:28Z","timestamp":1788182488432,"version":"build-2803163510"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease. About 5\u201310% require conversion to open surgery due to complex anatomy or intraoperative complications. Accurate preoperative prediction of difficult LC can improve surgical planning and patient counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To evaluate a preoperative scoring system\u2019s ability to predict difficult LC and guide surgical preparedness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Prospective observational study of 150 patients (21\u201380 years) undergoing elective LC. Preoperative clinical, biochemical, and ultrasound factors were scored (total 15 points) and patients stratified into risk categories. Analysis used chi-square\/Fisher\u2019s exact tests and ROC curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Difficult LC occurred in 22% (very difficult 2%). Significant predictors (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05) included: age &gt;60, male sex, history of cholecystitis, BMI &gt;25, supra-umbilical scar, elevated ALP, GB wall &gt;4 mm, impacted stone, contracted GB, and CBD &gt;7 mm. The model\u2019s AUC was 0.927; score &gt;6 predicted difficulty with 75.76% sensitivity and 98.29% specificity (LR+ 44.3).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The preoperative scoring system reliably predicts difficult LC. High-score patients (&gt;6) may be triaged to experienced surgeons or considered for early open conversion to reduce complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_316_25","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:18Z","timestamp":1769083218000},"page":"1168-1172","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative Prediction of Difficult Laparoscopic Cholecystectomy Using Scoring System: A Clinical Observational Study"],"prefix":"10.4103","volume":"25","author":[{"given":"Saicharan Reddy","family":"Nagarla","sequence":"first","affiliation":[{"name":"Department of General Surgery, Dr. D. Y. Patil Institute of Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahendra","family":"Wante","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dr. D. Y. Patil Institute of Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trupti","family":"Tonape","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dr. D. Y. Patil Institute of Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"R3-20260831","first-page":"1018","article-title":"Gallstones and laparoscopic cholecystectomy","volume":"269","year":"1992","journal-title":"JAMA"},{"key":"R4-20260831","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.ijsu.2013.05.037","article-title":"Validation of a scoring system to predict difficult laparoscopic cholecystectomy","volume":"11","author":"Gupta","year":"2013","journal-title":"Int J Surg"},{"key":"R5-20260831","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s12262-009-0055-y","article-title":"Preoperative prediction of difficult laparoscopic cholecystectomy: A scoring method","volume":"71","author":"Randhawa","year":"2009","journal-title":"Indian J Surg"},{"key":"R6-20260831","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/0972-9941.129947","article-title":"A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy","volume":"10","author":"Vivek","year":"2014","journal-title":"J Minim Access Surg"},{"key":"R7-20260831","first-page":"199","article-title":"Predicting difficult laparoscopic cholecystectomy using preoperative ultrasound","volume":"18","author":"Siddiqui","year":"2008","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"R8-20260831","first-page":"14","article-title":"Predicting difficulty level in laparoscopic cholecystectomy","volume":"21","author":"Goyal","year":"2015","journal-title":"Int J Surg"},{"key":"R9-20260831","first-page":"125","article-title":"Preoperative scoring system to predict difficult laparoscopic cholecystectomy","volume":"26","author":"Karim","year":"2020","journal-title":"Niger J Surg"},{"key":"R10-20260831","first-page":"1607","article-title":"Evaluation of preoperative predictive score to anticipate difficulty in laparoscopic cholecystectomy","volume":"4","author":"Agrawal","year":"2017","journal-title":"Int Surg J"},{"key":"R11-20260831","first-page":"PC05","article-title":"Pre-operative prediction of difficult laparoscopic cholecystectomy","volume":"10","author":"Joshi","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"R12-20260831","doi-asserted-by":"crossref","first-page":"3052","DOI":"10.18203\/2349-2902.isj20193639","article-title":"Evaluation of preoperative predictive factors for difficult laparoscopic cholecystectomy","volume":"6","author":"Elmaleh","year":"2019","journal-title":"Int Surg J"},{"key":"R13-20260831","doi-asserted-by":"crossref","first-page":"4965","DOI":"10.1007\/s00464-024-10911-x","article-title":"Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: A cohort study","volume":"38","author":"Ram\u00edrez-Giraldo","year":"2024","journal-title":"Surg Endosc"},{"key":"R14-20260831","doi-asserted-by":"crossref","first-page":"39","DOI":"10.29252\/jcbr.2.1.39","article-title":"Preoperative grading system versus intraoperative grading system as predictors for difficult laparoscopic cholecystectomy: a comparative validation study","volume":"2","author":"Sudhir","year":"2018","journal-title":"J Clin Basic Res"},{"key":"R15-20260831","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13017-015-0005-x","article-title":"Grading operative findings at laparoscopic cholecystectomy-a new scoring system","volume":"10","author":"Sugrue","year":"2015","journal-title":"World J Emerg Surg"},{"key":"R16-20260831","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.amjsurg.2016.04.003","article-title":"How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system","volume":"212","author":"Bourgouin","year":"2016","journal-title":"Am J Surg"},{"key":"R17-20260831","doi-asserted-by":"crossref","first-page":"95","DOI":"10.47372\/uajnas.2022.n1.a09","article-title":"Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy","volume":"26","author":"Bin-Gadeem","year":"2022","journal-title":"Univ Aden J Natl Appl Sci"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_316_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:01:24Z","timestamp":1788181284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_316_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_316_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]},"assertion":[{"value":"2025-07-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}