A nomogram may predict conversion of laparoscopic surgery to open surgery for choledocholithiasis.

A total of 867 choledocholithiasis patients who underwent laparoscopic surgery were randomly divided into a training and a validation group. A logistic regression analysis-based nomogram was constructed, and its predictive performance was evaluated using AUC, calibration curve, and DCA (decision curve analysis).

Key findings from the study are:

• The nomogram included Previous upper abdominal surgery, maximum diameter of stone ≥12 mm, medial wall of the duodenum stone,
• gallbladder wall and CBD wall thickening, stone size/CBD size ≥0.75, and simultaneous laparoscopic hepatectomy.
• The AUC values were 0.813 and 0.804 in the training and validation groups, respectively.
• The calibration curve presented excellent consistency between the nomogram predictions and actual observations.
• DCA presented a positive net benefit for the nomogram.

In our study, 25 out of 41 conversion surgeries for dense abdominal adhesions were due to PUAS. In our nomogram, stones in the medial wall of the duodenum scored higher with 86 points.

The maximum stone diameter was the transverse diameter perpendicular to the CBD wall. A large ratio increases the difficulty of stone removal. Removing IHD stones is more challenging than liver neoplasm due to the risk of liver inflammation, perihepatic adhesions, and anatomical distortion, the author writes.

Reference:

Zheng, Y et al. A nomogram to predict conversion of laparoscopic surgery to laparotomy for Choledocholithiasis. BMC Surg 23, 372 (2023).