Reaching a consensus on the definition of “difficult” cholecystectomy among Spanish experts. A Delphi project. A qualitative study

• DOI: 10.1016/j.ijsu.2022.106649
• Publication Date: 2022-05-04T12:04:16Z
• Authors: Alba Manuel-Vázquez; Raquel Latorre-Fr...; Cándido Alcázar; Paola Melgar Requena; Roberto de la Plaza; Gerardo Blanco Fe...; Mario Serradilla-...; J.M. Ramia; Martín Bailón Cud...; Juan Luis Blas Laina; Federico Castillo...; Ángel Cuadrado Ga...; Estaban Cugat And...; Daniel Díaz Gómez; David Fernández L...; Amador García Rui...; Miguel Ángel Góme...; Santiago López Ben; Alfonso Mansilla ...; Pablo Martí Cruchaga; David Martínez Ce...; Alberto Martínez ...; Aleix Martínez Pérez; Isabel Mora Oliver; Mikel Prieto; Salvador Morales ...; Carlos Moreno; Irene Ortega; Paola Fabiano; Antonio Picardo; Manuel Planells Roig; César Ramírez Plaza; Fernando Rotellar...; Santiago Azagra; Ramón Villalonga Puy; Jesús María del V...; Yolanda Quijano
• Keywords: Delphi Method; Delphi

Being able to predict preoperatively the difficulty of a cholecystectomy can increase safety and improve results. However, there is a need to reach a consensus on the definition of a cholecystectomy as "difficult". The aim of this study is to achieve a national expert consensus on this issue.A two-round Delphi study was performed. Based on the previous literature, history of biliary pathology, preoperative clinical, analytical, and radiological data, and intraoperative findings were selected as variables of interest and rated on a Likert scale. Inter-rater agreement was defined as "unanimous" when 100% of the participants gave an item the same rating on the Likert scale; as "consensus" when ≥80% agreed; as "majority" when the agreement was ≥70%. The delta of change between the two rounds was calculated.After the two rounds, the criteria that reached "consensus" were bile duct injury (96.77%), non-evident anatomy (93.55%), Mirizzi syndrome (93.55%), severe inflammation of Calot's triangle (90.32%), conversion to laparotomy (87.10%), time since last acute cholecystitis (83.87%), scleroatrophic gallbladder (80.65%) and pericholecystic abscess (80.65%).The ability to predict difficulty in cholecystectomy offers important advantages in terms of surgical safety. As a preliminary step, the items that define a surgical procedure as difficult should be established. Standardization of the criteria can provide scores to predict difficulty both preoperatively and intraoperatively, and thus allow the comparison of groups of similar difficulty.