الفهرس 
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Abstract
This study was carried out on 50 patients, with symptomatic gall stone disease. The aim of the study was to evaluate the adequacy of critical view of safety during laparoscopic cholecystectomy according to Strasberg’s criteria.
There were 46 patients (92%) females and 4 patients (8%) males. Their age ranged from 21y to 72y with a mean of 43.34 ± 15.04. The BMI of the patients ranged from 18.0 to 46 with a mean of 32.51 ± 6.088.
All cases subjected to through history taking and complete clinical examination. Laboratory investigations (aspartate aminotransferase, alanine aminotransferase, total and direct bilirubin, alkaline phosphatase, complete blood cell count) followed by ultrasonography.
Rt hypochondrial pain was a presenting symptom in all patients (100%). Fatty dyspepsia was a presenting symptom in 16 patients (32%). Nausea and vomiting was a presenting symptom in 17 patients (34%).
Four patients (8%) had a history of acute cholecystitis. one patient (2%) with acute pancreatitis. 4 patients (8%) obstructive jaundice. ERCP was done in 3 of them.
Ultrasonography showed, 31 patients (62.0%) were presented by small multiple stones, 9 patients (18.0 %) were presented by multiple large stones, while 8 patients (16.0%) were presented by single large stone and 2 patients (4.0%) were presented by single small stone. 33 patients (66.0 %) were presented by increased gall bladder wall thickness, while 17 patients (34.0%) were presented by average gall bladder wall thickness. 29 patients (58.0%) were presented by average sized gall bladder, 13 patients (26.0%) were presented by contracted gall bladder while 8 patients (16.0%) were presented by distended gall bladder.
All cases were done successfully without conversion to open cholecystectomy.
The operative time was ranged from 28.0 to 117.0 minutes, mean operative time 57.1± 18.93.
According to observer I the critical view of safety was achieved in 24 patients (48.0 %) while in 26 patients (52.0 %) the critical view of safety was inadequate with mean score 4.35 ± 0.85.
But according to observer II the critical view of safety was achieved in 23 patients (46.0 %) and inadequate critical view of safety was found in 27 patients (54.0 %) with mean score 4.37 ± 1.09.
The inter-observer agreement occurs in 37 patients (74.0%): 17 patients with adequate CVS and 20 patients with inadequate CVS, while disagreement between the observers in 13 patients (26.0 %).
Nine patients have developed intra-operative bleeding from operative field, 4 patients were with adequate critical view of safety according to both observer, while 5 patients were evaluated as inadequate critical view of safety. Gall bladder perforation were developed in 7 patients and was controlled by a grasper at the site of perforation, 3 patients were with adequate critical view of safety while 4 patients with inadequate critical view of safety.
There were no morbidities encountered post operatively in all patients.