Can the parkland grading scale predict the difficulty of laparoscopic cholecystectomy? A new approach to validation

Table 1 The Parkland Grading Scale for cholecystitis

Cholecystitis severity grade	Description of severity
1	Normal appearing gallbladder (“robin’s egg blue)
	No adhesions present
	Completely normal gallbladder
2	Minor adhesions at neck, otherwise normal gallbladder
2	Adhesions restricted to the neck or lower of the gallbladder
3	Presence of any of the following:
3	Hyperemia, pericholecystic fluid, adhesions to the body, or distended gallbladder
4	Presence of any of the following:
	Adhesions obscuring majority of gallbladder
	Grade 1–3 with abnormal liver anatomy, intrahepatic gallbladder, or impacted stone (Mirrizi)
5	Presence of any of the following:
5	Perforation, necrosis, or inability to visualize the gallbladder due to adhesions

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