Assessing Operative Difficulty of Post-ERCP Laparoscopic Cholecystectomy Using Nassar Grading

Introduction: Choledocholithiasis may present as a wide spectrum of clinical manifestations like abdominal pain, jaundice, cholangitis and gallstone pancreatitis. Endoscopic retrograde cholangiopancreatography is considered as treatment of choice for the management of common bile duct stones. Gallstones are further managed by laparoscopic cholecystectomy.

Aims and Objective: Assessing operative difficulty of post-ERCP laparoscopic cholecystectomy using Nassar grading

Method: A retrospective analysis was conducted in the Post Graduate Department of Minimal Access and General Surgery, Government Medical College, Srinagar to assess the operative difficulty in post ERCP cholecystectomy using NASSAR grading and included patients who underwent laparoscopic cholecystectomy 6–8 weeks post-ERCP.

Results: A total of 60 patients were included in this study. Among them 40 were females and 20 were males. The age of the patients included in the study had a range of 23-69 years with  mean age of 46 ±11.5 years. The average operative time was 59.25 minutes. All the patients underwent laparoscopic cholecystectomy with conversion of two cases to open cholecystectomy.

Conclusion: The Nassar Grading System effectively predicts the operative difficulty of post-ERCP laparoscopic cholecystectomy. Grades III and IV are associated with significantly longer operative times and higher complexity, emphasizing the importance of preoperative grading leading to better planning of cholecystectomy. Further studies with larger cohorts are recommended to validate these findings.