Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours After Hospital Admission

Yamamoto, Takehito; Komori, Junji; Morimoto, Takeshi; Kobayashi, Hiroyuki; Kaihara, Satoshi; Hosotani, Ryo

doi:10.9738/intsurg-d-16-00014.1

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Furthermore, risk factors evaluated via a presurgical CT scan vary. Among these factors, CT attenuation, 22 absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, 23 edema in the gallbladder wall, 13 and dirty fat signs 24 have been reported. However, to the best of our knowledge, none of the reports indicated that the maximum diameter of the gallbladder measured via a CT scan was a risk factor for difficult LC in patients with AC.…”

Section: Discussionmentioning

confidence: 99%

Maximum Diameter of the Gallbladder Determined Presurgically Using Computed Tomography as a Risk Factor for Difficult Emergency Laparoscopic Cholecystectomy in Patients With Mild to Moderate Acute Cholecystitis

Sasaki

Sakata

Nakano

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Early or emergency laparoscopic cholecystectomy (LC) was recommended in the 2018 Tokyo Guidelines for patients with mild to moderate acute cholecystitis (AC). Although surgical difficulty is frequently encountered during these surgeries, risk factors for predicting surgical difficulties have not been fully investigated, especially based on computed tomography (CT) findings. Materials and Methods:We investigated 72 patients who underwent emergency LC with mild (n = 45) to moderate (n = 27) AC. Patients who previously underwent presurgical percutaneous or endoscopic biliary drainage were excluded from this study. Difficult LC was defined using any of the following surgical factors: surgical duration ≥ 180 minutes, blood loss ≥ 300 g, or a conversion to open cholecystectomy. Subsequently, several presurgical clinical factors were analyzed, including sex, age at surgery, experience of the surgeon, interval between symptom onset and surgery, body mass index, diabetes history, presurgical white blood cell count, and C-reactive protein level. Moreover, stones in the cystic duct or perigallblader fluid and the maximum thickness and diameter of the gallbladders were evaluated via presurgical CT. Finally, logistic regression analysis was performed to compare the relationship between surgical difficulty and each clinical factor. Results:The average age at surgery of the included patients was 60.3 (range: 25 to 88 y), surgical duration was 112.2 (range: 29 to 296 min), and surgical blood loss was 55.2 (range: 0 to 530 g). Furthermore, 4 (5.6%) had to undergo open cholecystectomy, whereas postsurgical complications occurred in 5 (6.9%) patients. In addition, the mean postsurgical admission duration was 7 (range: 3 to 63 d). Thus, 12 patients experienced difficult LC, whereas 60 experienced nondifficult LC. Of the evaluated clinical factors, patients who experienced difficult LC showed higher presurgical C-reactive protein levels (10.78 vs. 6.76 mg/dL, P = 0.01) and wider gallbladder diameters (48.4 vs. 41.8 mm, P < 0.01) than those who experienced nondifficult LC. By univariate logistic regression analysis, results also showed that patients with a maximum gallbladder diameter had a higher risk of experiencing difficulty during emergency LC (P = 0.02). Moreover, the gallbladder diameter's cutoff value was 43 mm after the receiver operating characteristic curve analysis. Conclusions:In patients with mild to moderate AC, emergency LC can safely be performed. However, performing LC might be technically difficult in patients with AC after the identification of severe gallbladder swelling during presurgical CT.

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Section: Discussionmentioning

confidence: 99%

Maximum Diameter of the Gallbladder Determined Presurgically Using Computed Tomography as a Risk Factor for Difficult Emergency Laparoscopic Cholecystectomy in Patients With Mild to Moderate Acute Cholecystitis

Sasaki

Sakata

Nakano

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Patients with high BMI were having significantly difficulty LC which was also describe in previous studies across the world. [8][9][10][11][12] Further analysis showed that 75% of cases with obesity and all the cases having morbid obese had difficulty LC.…”

Section: Discussionmentioning

confidence: 99%

A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

et al. 2019

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Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.

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C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights

et al. 2020

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The gallbladder is an important component of the hepatobiliary system whose primary function is to aid in digestion of foodstuffs, excretion of drugs and facilitate removal of waste products from the body. The gall bladder is principally a storage organ for bile, chemically modified salts and acids of cholesterol which are synthesized in the liver and which function as surfactants to solubilize fatty substances of limited aqueous solubility. Any disruption in the amount or activity of bile surfactant can lead to an accumulation of insoluble molecular clumps (e.g., gallstones) that deposit in and obstruct fluid movement within the gallbladder, and which can lead to pathological congestion and tissue damage. The natural host defense response to any event that causes tissue damage is to stimulate inflammation, which non-specifically but aggressively reacts to the stimuli so to remove the cause and repair damaged tissues. The C-reactive protein (CRP) is a primarily hepatically produced serum protein whose blood levels increase within 6-10 h of any tissue-damaging event. The extent with which it increases correlates with the level of tissue damage and associated inflammation. CRP levels are reported to be of value in diagnosing acute cholecystitis severity, in predicting the outcome and prognosis of cancerassociated gallbladder resection, and in helping identify cystic structures during emergency laparoscopic cholecystectomies. As an understanding of distinctive CRP structural isoforms is evolving, its role not only as a biomarker but as regulator of both physiologic and pathophysiologic processes of inflammation may be relevant in the understanding of and treatment approaches for gallbladderassociated disease.

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Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours After Hospital Admission

Cited by 3 publications

References 24 publications

Maximum Diameter of the Gallbladder Determined Presurgically Using Computed Tomography as a Risk Factor for Difficult Emergency Laparoscopic Cholecystectomy in Patients With Mild to Moderate Acute Cholecystitis

Maximum Diameter of the Gallbladder Determined Presurgically Using Computed Tomography as a Risk Factor for Difficult Emergency Laparoscopic Cholecystectomy in Patients With Mild to Moderate Acute Cholecystitis

A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights

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