Discussion
hepatolithiasis
MINOR, CAVITY, ADHESIONS
Accurate preoperative stratification and intraoperative conversion to open surgery are key factors for controlling the quality of laparoscopic surgery and patient safety [In our cohort, 25 of the 41 patients who underwent conversion surgery because of dense abdominal adhesions had PUAS. PUAS can lead to extensive adhesions in the abdominal cavity and changes in the anatomical structure of the hepatic hilum. A previous autopsy confirmed that the incidence of abdominal adhesions after minor surgery, major surgery, and multiple abdominal surgeries were 51, 72, and 93%, respectively [Tosun et al. [In our nomogram, stone in the medial wall of the duodenum had a higher score (points = 86). Nobel et al. [Xu et al. [As shown in Table We propose that laparoscopic surgery should be actively performed in low-risk patients. However, we recommend that additional surgical plans, such as ERCP + LC and open surgery, should be made before surgery for high-risk patients. We also recommend allocating low-risk patients to junior surgeons and high-risk patients to senior surgeons.Our study had certain limitations. Firstly, this was a retrospective study based on the patients’ database. Selection bias cannot be completely ruled out, and prospective data are needed to further validate our prediction model in the future. Secondly, this was a single-center study, so the generalizability of our nomogram needs to be further validated in multicenter studies. We did not include variables like the type of PUAS, characteristics of hepatolithiasis, and the presence or absence of emergency surgery.