CholeS Score for Duration of Laparoscopic Cholecystectomy
Validated scoring system predicting operative difficulty and duration of laparoscopic cholecystectomy. Used for preoperative consent and surgical planning, particularly relevant for out-of-hours or high-risk scheduling decisions.
Score interpretation
CholeS 0-3 -- expected short operative duration; suitable for day-case laparoscopic cholecystectomy
→ Day-case laparoscopic cholecystectomy appropriate (NICE: preferred over inpatient stay); standard port placement; experienced registrar or ST5+ can perform; consent for conversion risk approximately 1%; standard pre-operative assessment; inform patient: return to work typically 1-2 weeks; pain: regular paracetamol + ibuprofen; driving: 1-2 weeks post-operatively.
CholeS 4-6 -- moderate difficulty anticipated; enhanced surgical planning required
→ Inpatient admission preferred over day-case; consultant or senior registrar (ST7+) involvement; confirm ERCP pre-operatively if CBD stones confirmed; on-table cholangiogram planning; discuss conversion risk (~3%) with patient; consider timing: avoid emergency/overnight unless absolutely necessary; pre-op bowel prep not required; enhanced recovery pathway; ensure HDU backup available; anti-emetics prophylaxis (PONV risk); discuss risk of bile duct injury (1/300 in routine, higher in complex).
CholeS >= 7 -- high complexity; prolonged operative duration and increased conversion risk
→ Consultant surgeon only; consider referral to hepatobiliary specialist centre if Mirizzi syndrome, porcelain gallbladder, or previous extensive upper GI surgery; ERCP pre-operatively for CBD stones (endoscopic clearance before cholecystectomy vs rendezvous procedure); MRI/MRCP if biliary anatomy uncertain; percutaneous cholecystostomy as temporising measure for acute cholecystitis if fitness for surgery poor; HDU bed booking pre-operatively; extended informed consent: conversion risk ~10-15%, bile duct injury risk; possible open cholecystectomy primary planned; intra-op cholangiography mandatory; subtotal/fundus-first cholecystectomy technique if Calot triangle unclear; critical view of safety documentation essential.
Interpretation bands for the CholeS Score. Apply clinical judgement and local guidance.
References
- Bharamgoudar R et al. The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy (CholeS). Surg Endosc. 2018;32(7):3002-3010.
- NICE NG188. Gallstone disease: diagnosis and management. NICE. 2014 (updated 2022).
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Atracurium Besilate · Non-depolarising Neuromuscular Blocking Agent (Intermediate Duration)
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Potassium Iodide / Lugol's Solution · Thyroid Blocking Agent / Pre-operative Thyroid Preparation
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.