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Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence

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Abstract

Purpose

Recently, bail-out cholecystectomy (BOC) during laparoscopic cholecystectomy to avoid severe complications, such as vasculobiliary injury, has become widely used and increased in prevalence. However, current predictive factors or scoring systems are insufficient. Therefore, in this study, we aimed to test the validity of existing scoring systems and determine a suitable cutoff value for predicting BOC.

Methods

We retrospectively assessed 305 patients who underwent laparoscopic cholecystectomy and divided them into a total cholecystectomy group (n = 265) and a BOC group (n = 40). Preoperative and operative findings were collected, and cutoff values for the existing scoring systems (Kama’s and Nassar’s) were modified using a prospectively maintained database.

Results

The BOC rate was 13% with no severe complications. A logistic regression analysis revealed that the Kama’s score (odds ratio, 0.93; 95% confidence interval 0.91–0.96; P < 0.01) was an independent predictor of BOC. A cutoff value of 6.5 points gave an area under the curve of 0.81, with a sensitivity of 87% and a specificity of 67%.

Conclusions

Kama’s difficulty scoring system with a modified cutoff value (6.5 points) is effective for predicting BOC.

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Abbreviations

LC:

Laparoscopic cholecystectomy

GB:

Gallbladder

BDI:

Bile duct injury

VBI:

Vasculo-biliary injury

CVS:

Critical view of safety

BOC:

Bail-out cholecystectomy

STC:

Subtotal cholecystectomy

LTC:

Laparoscopic total cholecystectomy

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

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Funding

The authors declare that this research was conducted in the absence of any commercial or financial relationships.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan

    Ryota Ito, Ryuji Yoshioka, Yu Gyoda, Mamiko Miyashita, Ryoji Furuya, Masahiro Fujisawa, Fumihiro Kawano, Yoshinori Takeda, Hirofumi Ichida, Yoshihiro Mise & Akio Saiura

Authors
  1. Ryota Ito
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  2. Ryuji Yoshioka
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  3. Yu Gyoda
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  4. Mamiko Miyashita
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  5. Ryoji Furuya
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  6. Masahiro Fujisawa
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  7. Fumihiro Kawano
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  8. Yoshinori Takeda
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  9. Hirofumi Ichida
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  10. Yoshihiro Mise
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  11. Akio Saiura
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Contributions

RI, RY, YG, and AS contributed to the study conception and design. RI and YG collected data. RI performed the statistical analyses. All authors were responsible for interpreting the data, writing the manuscript, and approving the manuscript for submission.

Corresponding author

Correspondence to Akio Saiura.

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Conflict of interest

None of the authors has any potential conflicts of interest to disclose.

Ethics approval and consent to participate

This retrospective study was approved by our institutional review board (approval number: E22-0302).

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The requirement for informed consent from patients was waived because of the retrospective nature of the study.

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Ito, R., Yoshioka, R., Gyoda, Y. et al. Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence. Surg Today (2024). https://doi.org/10.1007/s00595-024-02854-6

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  • DOI: https://doi.org/10.1007/s00595-024-02854-6

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