Use of the Parkland scale in the intraoperative approach to acute cholecystitis and the choice of subtotal cholecystectomy

Abstract

This investigation addresses the problem of acute cholecystitis, a sudden inflammation of the gallbladder that can become complicated and require laparoscopic cholecystectomy, the gold standard treatment. The study focuses on the complexity of this surgery, influenced by factors such as inflammation, the patient's clinical history and the condition of the gallbladder wall. It is noted that, although most cholecystectomies are successful, complex acute cholecystitis may require conversions to open surgery or changes in surgical technique, suggesting subtotal cholecystectomy as a rescue technique. The main objective is to analyze the medical literature to identify clinical factors that influence the choice of subtotal cholecystectomy and evaluate the relationship between Parkland Scale scores and the surgical decision, in order to establish its predictive validity. A methodological approach was used based on the review of cases of acute cholecystitis and the application of the Parkland Scale to predict surgical difficulty and the need for rescue techniques. The results show that the Parkland Scale is a useful tool to stratify disease severity and predict challenges during laparoscopic cholecystectomy, with a significant correlation between high scores and the choice of subtotal cholecystectomy. In conclusion, this study highlights the importance of the Parkland Scale and subtotal cholecystectomy in the management of complex acute cholecystitis, offering a valuable guide for clinical decision making in situations of difficult surgical access.