Table 2.
Operative Grading System for Cholecystitis Severity
| Gallbladder appearance | |||||||
|---|---|---|---|---|---|---|---|
| Adhesions < 50% of GB | 1 | ||||||
| Adhesions burying GB | 3 | ||||||
| Max | 3 | ||||||
| Distension/Contraction | |||||||
| Distended GB (or contracted shrivelled GB) | 1 | ||||||
| Unable to grasp with atraumatic laparoscopic forceps | 1 | ||||||
| Stone ≥1 cm impacted in Hartman’s Pouch | 1 | ||||||
| Access | |||||||
| BMI >30 | 1 | ||||||
| Adhesions from previous surgery limiting access | 1 | ||||||
| Severe Sepsis/Complications | |||||||
| Bile or Pus outside GB | 1 | ||||||
| Time to identify cystic artery and duct >90 minutes | 1 | ||||||
| Total Max | 10 | ||||||
| Degree of difficulty | |||||||
| A Mild | <2 | ||||||
| B Moderate | 2–4 | ||||||
| C Severe | 5–7 | ||||||
| D Extreme | 8–10 | ||||||