Topography of Pericholecystic Adhesions as a Determinant of Operative Difficulty During Laparoscopic Cholecystectomy Using the Parkland Grading Scale: A Prospective Observational Study.

Background Adhesions around the gallbladder are a major cause of difficulty during laparoscopic cholecystectomy (LC). While the presence of adhesions has been widely discussed, the exact location of these adhesions and their influence on operative difficulty have rarely been studied. Aim To evaluate whether the anatomical location of pericholecystic adhesions (neck, body, whole gallbladder, or absent) correlates with operative difficulty as assessed by the Parkland Grading Scale (PGS). Methods A prospective observational study of 100 patients undergoing LC was conducted. During the initial laparoscopic view, the location of adhesions was documented and categorized into four groups. These were correlated with Parkland grades recorded intraoperatively. Results Adhesions were absent in 59 cases (59%), predominantly corresponding to Parkland Grade 1. Neck adhesions were present in 23 cases (23%) and showed a strong association with higher Parkland grades. Whole gallbladder adhesions were observed in eight cases (8%) and were consistently associated with Grades 4 and 5. Body adhesions were identified in 10 cases (10%) and demonstrated an intermediate association with operative difficulty. Conclusions The location of adhesions is a significant determinant of operative difficulty. Neck and whole gallbladder adhesions predict higher operative complexity and should alert the surgeon to anticipate difficult dissection early.