“CORRELATION OF INTRAOPERATIVE DIFFICULTY SCORE WITH HISTOPATHOLOGY FINDINGS IN CHOLECYSTECTOMY: A CROSS-SECTIONAL STUDY”

Abstract

Cholecystectomy is one of the most commonly performed general surgical procedures, and the intraoperative difficulty encountered varies widely depending on underlying gallbladder pathology. Correlating intraoperative difficulty with histopathological findings may help improve operative planning and predict complications.

Objective: To assess the correlation between the Intraoperative Difficulty Score (IODS) and histopathological findings in patients undergoing cholecystectomy.

Methods: This cross-sectional study included 120 patients who underwent elective or emergency cholecystectomy over one year at a tertiary care hospital. Intraoperative difficulty was graded using a standard IODS based on adhesions, gallbladder wall thickness, distension, Calot’s triangle anatomy, bile spillage, and need for conversion. All gallbladder specimens were examined histopathologically and categorized into chronic cholecystitis, acute cholecystitis, acute-on-chronic cholecystitis, xanthogranulomatous cholecystitis, gangrenous cholecystitis, and other variants. The correlation between IODS and histopathological severity was assessed using appropriate statistical tests.

Results: Among the 120 patients, most specimens showed chronic or acute-on-chronic cholecystitis, while complicated forms such as gangrenous and xanthogranulomatous pathology were less common. A significant positive correlation was found between IODS and histopathological severity, with higher difficulty scores associated with more advanced inflammatory changes. Emergency procedures and cases with dense adhesions exhibited higher difficulty levels.

Conclusion: The intraoperative difficulty score demonstrates a meaningful correlation with histopathological severity in cholecystectomy. Routine use of standardized difficulty scoring may aid in surgical decision-making, preoperative risk assessment, and patient counseling.