1. Appearance around the gallbladder

1-1. No fibrotic change

1-2. Fibrotic adhesions around the gallbladder due to inflammation

1-3. Partial scarring adhesions around the gallbladder

1-4. Diffuse scarring adhesions around the gallbladder

2. Appearance of the Calotʼs triangle area

2-1. No fibrotic change

2-2. Sparse fibrotic change in the Calotʼs triangle area

2-3. Dense fibrotic change but no scarring in the Calotʼs triangle area

2-4. Partial scarring in the Calotʼs triangle area

2-5. Diffuse scarring in the Calotʼs triangle area

3. Appearance of the gallbladder bed

3-1. No fibrotic change

3-2. Sparse fibrotic change in the gallbladder bed

3-3. Dense fibrotic change but no scarring in the gallbladder bed

3-4. Partial scarring in the gallbladder bed

3-5. Diffuse scarring in the gallbladder bed (includes atrophic gallbladder with no lumen due to severe contraction) 　

4. Additional findings of the gallbladder and its surroundings

4-1. Edematous change around the gallbladder/in the Calotʼs triangle area/in the gallbladder bed

Definition: Excessive accumulation of interstitial fluid in the gallbladder perimuscular connective tissue (the so-called subserosal layer)
Description: Marked accumulation of interstitial fluid in the perimuscular connective tissue (the so-called subserosal layer)

Yes

No

4-2. Easy bleeding at dissection around the gallbladder/in the Calotʼs triangle area/in the gallbladder bed

Definition: Persistent venous bleeding in two or more sites upon dissection around the gallbladder/in the Calot’s triangle area/in the gallbladder bed that obstructs operative procedures. Select “No” if bleeding is due to insufficient hemostatic maneuvers or misidentification of the surgical plane or blood vessel (cutting into the liver, arterial injury, etc.).

Yes

No (1)

No (2)

4-3. Necrotic changes around the gallbladder/in the Calotʼs triangle area/in the gallbladder bed

4-4. Non-iatrogenic, perforated gallbladder wall and/or abscess formation towards the abdominal cavity noted during adhesiolysis around the gallbladder

4-5. Abscess formation towards the liver parenchyma

4-6. Cholecysto-enteric fistula

4-7. Cholecysto-choledochal fistula (included in the expanded classification of Mirizzi syndrome)

4-8. Impacted gallstone in the confluence of the cystic, common hepatic, and common bile duct (included in the expanded classification of Mirizzi syndrome)

5. Intra-abdominal factors unrelated to inflammation

5-1. Excessive visceral fat

5-2. Inversion of the gallbladder in the gallbladder bed due to liver cirrhosis

5-3. Collateral vein formation due to liver cirrhosis

5-4. Non-inflammatory (physiological) adhesion around the gallbladder

5-5. Anomalous bile duct

5-6. Gallbladder neck mounting on the common bile duct