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A cross-sectional analytical study stratified patients by a preoperative grading system into low, intermediate, and high risk groups and compared these with intraoperative Nassar difficulty levels. Among 405 participants, difficult cases were identified and risk associations were evaluated, while demographic, laboratory, and radiological data supported analysis. Limitations included single-center reliance, supporting multicenter validation and additional predictors.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/preoperative-prediction-of-difficult-laparoscopic-cholecystectomy-an-institutional-cross-sectional-study/435543/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/preoperative-prediction-of-difficult-laparoscopic-cholecystectomy-an-institutional-cross-sectional-study/435543.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1790064749","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the purpose of the study?","Question",{"text":112,"@type":113},"To evaluate the prognostic utility of a preoperative scoring system and identify predictive variables for laparoscopic cholecystectomy complexity in a tertiary care institution.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were patients classified preoperatively and intraoperatively?",{"text":117,"@type":113},"Preoperative grading stratified patients into low (0–1), intermediate (2–6), and high (7–19) risk groups, while intraoperative Nassar grading categorized difficulty from Grade 1 to Grade 4.",{"name":119,"@type":110,"acceptedAnswer":120},"What proportion of cases were considered easy versus difficult intraoperatively?",{"text":121,"@type":113},"Intraoperative assessment showed 72.8% of cases were easy and 27.2% were difficult according to the Nassar grading guideline.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435543,1790811433,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747859154,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Cross-sectional Study  \nPreoperative prediction of difficult laparoscopiccholecystectomy: an institutional cross-sectional study  \nSunil Basukala, MDHA, MSa , Sunischit Chandra Neupane, MBBSb ,*, Oshan Shrestha, MBBSb , Niranjan Thapa, MBBSb , Sulav Neupane, MBBSb , Sujan Tamang, MBBSb  \nBackground: Laparoscopic cholecystectomy (LC), a minimally invasive surgical procedure has largely replaced the open technique for cholecystectomies since the early 1990s and is the treatment of choice for the management of symptomatic gall stone diseases. It has been proved to be an effective and safe procedure in both elective and emergency conditions. However, conversion to open surgery in 2%–10% becomes inevitable. Moreover, surgeons assess difficulty intraoperatively. Preoperative prediction, vital for planning, relies on accurate scoring systems for surgical complexity. In this study, we aimed to evaluate the prognostic utility of a preoperative scoring system and identify predictive variables for LC complexity in a tertiary care institution.  \nMaterials and Methods: A cross-sectional analytical study was conducted among patients where the preoperative grading system stratified patients into three risk groups: low risk (0–1 score), intermediate risk (2–6 scores), and high risk (7–19 scores) . The intraoperative Nassar grading categorized patients into four difficulty levels, ranging from Grade 1 (least difficult) to Grade 4 (most difficult) . Dichotomization was adopted to provide a clinically useful distinction between “easy” and “difficult” cases, reflecting real-world operative decision-making. This preoperative scoring scale was employed for assessment and analyzed using SPSS-25 .  \nResults: Among 405 consenting participants, 41.2% were males, and 58.8% were females. The mean age was  \n50.49 ± 14.56 years (Mean ± SD), ranging from 17 to 80. The majority had primary diagnosis of biliary colic (31 .4%) followed by chronic cholecystitis (31 . 1%) . Thickened gallbladder walls were noted in 40.5%, common bile duct dilation in 17.5%, with 19.5% undergoing preoperative endoscopic retrograde cholangiopancreatography. Anticipated difficult LC was estimated in 158 patients. Intraoperative assessment, utilizing the Nassar grading guideline, revealed that 72.8% of cases were categorized as easy, while 27.2% were classified as difficult.  \nConclusion: This prospective study demonstrates a clear association between various risk factors and challenging LC. Overview data collection, encompassing demographic, laboratory, and radiological information, supported analytical assessments. However, reliance on a single tertiary care center is a notable limitation, underscoring the need for multicenter studies to validate and identify additional predictors of complexity in LC.  \nKeywords: ERCP, laparoscopic cholecystectomy, Nassar grading  \naDepartment of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal and bCollege of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal. Tel.: +9779861523707.  \n[E-mail: sunischit.chandraneupane08@naihs.edu.np](E-mail: sunischit.chandraneupane08@naihs.edu.np) (S. C. Neupane).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nAnnals of Medicine & Surgery (2026) 88:144–150  \nReceived 16 June 2025; Accepted 25 October 2025  \nSupplemental Digital Content is available for this article. Direct URL citations ","cbCain68zNUayUQf","https://ap.wps.com/l/cbCain68zNUayUQf","pdf",378573,"English","# Background\n# Materials and Methods\n# Results\n# Conclusion\n# Introduction\n# Keywords","[{\"question\":\"What was the purpose of the study?\",\"answer\":\"To evaluate the prognostic utility of a preoperative scoring system and identify predictive variables for laparoscopic cholecystectomy complexity in a tertiary care institution.\"},{\"question\":\"How were patients classified preoperatively and intraoperatively?\",\"answer\":\"Preoperative grading stratified patients into low (0–1), intermediate (2–6), and high (7–19) risk groups, while intraoperative Nassar grading categorized difficulty from Grade 1 to Grade 4.\"},{\"question\":\"What proportion of cases were considered easy versus difficult intraoperatively?\",\"answer\":\"Intraoperative assessment showed 72.8% of cases were easy and 27.2% were difficult according to the Nassar grading guideline.\"}]","Preoperative prediction of difficult laparoscopic cholecystectomy - An institutional cross-sectional study | PDF",1790674049,18]