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New Classification of Acute Cholecystitis According to Transoperative Features. Presentation of a Descriptive Transoperative Features Table in Cases of Acute Cholecystitis and That Allows Grade the Severity of the Illness. First Step: Validation and Interobserver Correlation
Raul Gaxiola^*1,2, Norma Eleane Basurto-Acevedo¹, SANDRA LUZ BRIONES-FRAGA³, ARTURO REDING-BERNAL^4
1GENERAL SURGERY, HOSPITAL GENERAL DE MEXICO, Mexico City, DISTRITO FEDERAL, Mexico; ²GASTROINTESTINAL SURGERY, HOSPITAL ANGELES DEL PEDREGAL, MEXICO CITY, Mexico; ³GASTROENTEROLOGY, HOSPITAL GENERAL DE MEXICO, MEXICO CITY, D.F., Mexico; ⁴DIRECCION DE INVESTIGACION, HOSPITAL GENERAL DE MEXICO, MEXICO CITY, Mexico

BACKGROUND. Acute cholecystitis is one of the most common causes of surgery in the emergency room services around the world. Nevertheless, description of transoperative features haven’t been standardized, so it hasn’t been able to classify acute cholecystitis. Nowadays, in the laparoscopic era, we have the possibility to review the cholecystectomy surgery videos and through a “transoperative features table” and now we are able to grade acute cholecystitis. OBJECTIVE: To validate a table which collects the macroscopic transoperative features in laparoscopic cholecystectomy in cases of acute cholecystitis and allows to grade the severity of the cholecystitis according to the proposed values for each one of them. METHODOLOGY: Twenty expert surgeons rated each one of the twenty patients after watching the initial part of their cholecystectomy videos. The study was blind. Each evaluator answered a questionnaire of 12 items each with a certain score. At the end we summed all the items and we classified the results in phases ranging from a 0 to a 4 phase according to its score. A kappa test with more than two ratings, and more than two raters but with constant number of raters was realized to assess the degree of agreement using the software STATA v.13. RESULTS: According to kappa index, the degree of agreement of the experts was as follows: fair (0.2454), moderate (0.4004), fair (0.2699) and fair (0.2687) for phase 0, phase 1, phase 2 and phase 3 respectively. No rating was made for phase 4.The combined weighted average kappa was fair (0.3083). CONCLUSION: The concordance grade of the leader board for degrees of cholecystitis was acceptable, and could be useful as a grading tool for acute cholecystitis.

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