Table 1 Summary of studies reporting severity scoring system for laparoscopic cholecystectomy

Vivek et al. Prospective (n = 323)

Male gender, Previous attacks of AC, Previous upper abdominal surgery

Multiple stones Peripancreatic fluid collection

Cirrhotic liver Contracted/distended GB Inflamed GB Ductal anomalies Adhesions

Max score of 44 (with 9 predicting difficult LC), sensitivity of 85% & specificity of 97.8%. ROC of 0.96.

Gupta et al. Prospective (n = 210) All underwent elective LC.

History of previous hospitalization due to AC, Palpable GB

Thickened (≥4 mm) GB wall, Impacted stone

N/A

Min score 0 (easy) Max score 15 (very difficult). Conversion rate 4.28% ROC of 0.86. PPV for easy and difficult LC were 90% and 88% respectively.

Randhawa et al. Prospective (n = 228)

BMI >27.5, Previous hospitalization due to AC, Palpable GB

Thickened (≥4 mm) GB wall

N/A

Conversion rate of 1.31%. ROC of 0.82. PPV for easy and difficult LC were 88.8% and 92.2% respectively.

Kanakala et al. Initially retrospective then prospective (n = 2117)

Male gender, ASA II and III

N/A

N/A

Conversion rate of 6.3%.

Bouarfa et al. Retrospective (n = 337) All underwent elective LC.

Male gender, High BMI

GB wall thickening (>2 mm), GB wall inflammation

N/A

Classification algorithms based on preoperative patient data to predict intraoperative complexity, with an accuracy of 83%.

Kama et al. Retrospective (n = 1000)

Age ≥ 60 (p = 0.052), Male gender, Abdominal tenderness, Previous upper abdominal operation

Thickened GB wall (>4 mm), Previous attacks of AC

N/A

Conversion rate of 4.8%. Both a constant and coefficient were calculated for each parameter; the sum of both gives a score for the patient

Kologlu et al. Prospective (n = 400)

This was a validation of the study by Kama et al. using the RSCLO score. Increasing RSCLO scores correlated with higher conversion rates. Conversion rate of 3%.

Lal P et al. Prospective (n = 73) All underwent elective LC.

N/A

GB wall thickness (>4 mm), Contracted GB, Stone impaction at Hartmann’s pouch.

Total operating time (>90mins), Time taken to dissect GB bed/Calot’s triangle (>20 mins), Spillage of stones, Tear of GB during dissection, Conversion to open were chosen as parameters describing a difficult LC.

Conversion rate of 23.3%. PPV of GB thickness, stone impaction and contracted GB to predict conversion to open were 70%, 63.6% and 45.4%, respectively, with a combined overall ultrasonographic PPV of 61.9%.

Schrenk et al. Prospective with 2 arms (n = 640 altogether)

RUQ pain, Rigidity in RUQ, Previous upper abdominal surgery, biliary colic in last 3 weeks, WCC > 10 x 10⁹/L

GB wall thickening (>5 mm), Hydroptic GB, Pericholecystic fluid, Shrunken GB, No GB filling on preoperative IV cholangiography/incarcerated cystic duct stone (on U/S)

N/A

Conversion rate of 8.2%. 5 possible scores, ranging from 0–9 (with 0 = easy LC and ≥4 = conversion to open expected). PPV of 80%.

Rosen et al. Retrospective (n = 1347) undergoing both elective and non-elective LC.

Age, BMI, AC

GB wall thickness

N/A

Conversion rate of 5.3%. For elective LC, BMI >40 and GB wall thickness > 4 mm predicted conversion. For non-elective LC, ASA >2 predicted conversion.

Nachnani et al. Prospective (n = 105)

Male gender, Previous abdominal surgery, BMI > 30, Previous AC/acute pancreatitis

GB wall thickness > 3 mm

N/A

Conversion rate of 11.4%.

Abdel-Baki et al. (n = 40)

N/A

GB wall thickness (≥3 mm), Liver fibrosis

N/A

Conversion rate of 0.42%.

Daradkeh et al. Prospective (n = 160)

N/A

GB wall thickness (>3 mm), CBD diameter (≥7 mm)

N/A

Conversion rate of 2.5%. Adjusted r ² for U/S parameters was 0.25.

Bulbuller et al. Prospective (n = 571)

N/A

N/A

N/A

Conversion rate of 3.3%. Evaluation of RSCLO score showed good correlation with conversion to open, with a PPV of 43%, NPV of 100%, sensitivity of 100% and specificity of 96%.

Kwon et al. Retrospective (n = 305) All patients underwent ERCP and EST prior to LC (acute or elective).

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This study evaluated risk factors for conversion to open surgery in patients who underwent prior ERCP and EST for choledochocystolithiasis. Cholecystitis, mechanical lithotripsy and ≥ 2 CBD stones predicted open surgery. Conversion rate of 15.7%.

Lipman et al. Retrospective (n = 1377)

Male gender, Elevated WCC (≥11,000/μL), Low serum albumin (<3.5 g/dL), Diabetes Mellitus, Elevated total bilirubin (≥1.5 g/dL)

Pericholecystic fluid

N/A

Conversion rate of 8.1%. ROC of model was 0.83.