Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: A prospective study

Teckchandani, Narinder; Garg, Pankaj Kumar; Hadke, Niladhar S.; Jain, Sudhir; Kant, Ravi; Mandal, Ashish Kumar

doi:10.1016/j.ijsu.2010.05.014

Cited by 27 publications

(27 citation statements)

References 15 publications

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“…7,[16][17][18]20 However, the conversion rate is reported to be higher in acute cholecystitis, at 13-28%. 8,19,[21][22][23][24] This is similar to the conversion rate of 21.9% identified in our study (16 of 73 cases).…”

Section: Discussionsupporting

confidence: 88%

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

Yamamoto

Komori

Morimoto

et al. 2017

International Surgery

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The objective of this study was to identify preoperative factors predicting operative difficulty in patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours after hospital admission. Many reports have described the superiority of performing laparoscopic cholecystectomy in the early phase of acute cholecystitis. Recently, even earlier cholecystectomy within 24 hours after hospital admission has been recommended. However, the factors that influence surgical difficulty in this patient population have not been well scrutinized. We analyzed patients who underwent laparoscopic cholecystectomy for acute cholecystitis within 24 hours of hospital presentation from 2007 to 2015. The primary outcome was the operation time. We also analyzed the amount of blood loss and the rate of conversion to open surgery. Seventythree patients were enrolled. Mean age at surgery was 66 6 16 years, and 52 patients were male. The mean operation time was 128 6 59 minutes. Body mass index 25 kg/m 2 [odds ratio (OR) ¼ 3.6; 95% confidence interval (CI): 1.4-30.9] and dirty fat sign on preoperative computed tomography (OR ¼ 5.3; 95% CI: 1.0-34.2) were significantly associated with

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Section: Discussionsupporting

confidence: 88%

“…The cutoff values for white blood cell (WBC) count, C-reactive protein (CRP), and gallbladder wall thickness were determined by referring to other reports. 7,8 The protocol for this study was approved by our hospital's institutional review board; informed consent was waived because of the historical cohort nature of the study.…”

Section: Methodsmentioning

confidence: 99%

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

Yamamoto

Komori

Morimoto

et al. 2017

International Surgery

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“…In literature, percentages of conversion for acute cholecystitis of 4.5-29% are reported (14)(15)(16)(17)(18)(19), with the higher percentages generally presented in the early nineties, when surgeons were generally still in their learning curve. Literature suggests that successful LC is associated with younger age (19)(20), as our data show, although others have failed to show this difference (16,17). Few studies have focused on the right timing of surgical intervention for acute cholecystitis (16,18,19,21); in general, 3 to 4 days of complaints have been found to be the cut-off point after which significant rises in conversion occur.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Conversion during Laparoscopic Cholecystectomy — Experiences from a General Teaching Hospital

et al. 2011

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Background and Aims: laparoscopic cholecystectomy (lc) is the gold standard for treating symptomatic cholelithiasis. conversion, however, is sometimes necessary. the aim of this study was to determine predictive factors of conversion in patients undergoing lc for various indications in elective and acute settings in a general teaching hospital. Results: conversion to open cholecystectomy was performed in 121 patients (12%). the most frequent reasons for conversion were infiltration/fibrosis of calot's triangle (30%) and adhesions (27%). in the multivariate analyses male gender (oR 1.67, 95% ci 1.07-2.59), age > 65 years (oR 2.10, 95% ci 1.32-3.34), acute cholecystitis (oR 11.8, 95% ci 6.98-20.1), recent acute cholecystitis (oR 4.71, 95% ci 2.42-9.18) and recent obstructive jaundice (oR 20.6, 95% ci 4.52-94.1) were independent predictive factors for conversion.Conclusions: male gender, age > 65 years, (recent) acute cholecystitis and recent obstructive jaundice are independent predictive risk factors for conversion. by appreciating these risk factors for conversion, preoperative patient counselling can be improved.

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“…It is in contrast to the reports that the male sex is associated with higher failure rates of laparoscopic surgery. 8 However; the number of patients recruited in the study was 30 and only three patients required conversion. Therefore, it is relatively difficult to comment precisely about the gender relationships to failure rate unless the number of patients recruited is large and more precise statistical significance is obtained.…”

Section: Discussionmentioning

confidence: 99%

hsCRP levels as predictor of difficult laparoscopic cholecystectomy- current status evaluation experience in a teaching institution

et al. 2017

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Background: CRP, an acute phase reactant, is known to increase up to 1000 folds following inflammation and/or infection, but it's utility as a significant predictor of difficult LC or need for conversion to OC still remains controversial. Limited studies on levels of hsCRP and its association with difficult cholecystectomy are available in literature, especially in Indian context. It is hypothesized that levels of hsCRP pre-operatively for a given population or an individual patient if high would help a surgeon anticipate better a difficult LC, avoid excessive intra-operative manipulations, go for conversion early, reduce time of surgery and hence also minimise post-operative complications. Methods: The present included 30 clinically diagnosed 'cholecystitis with cholelithiasis' patients, and 30 healthy individuals. For accurate comparison of hsCRP levels, a fasting and post-operative, 6 and 12 hours, blood samples were analyzed by ELISA test. Pre-and post-operative hsCRP values were recorded and analyzed using multi-user licensed SPSS-Version 21.0. Results: The mean value of hsCRP in controls was 1.43mg/L. In study group, in pre-operative serum samples, the concentration was 20.46 mg/l. At 6 and 12 hours post-operative periods, the mean values observed were 24.4mg/L and 23.7 mg/L respectively. Compared with controls, the mean values are fairly high and statistically also significant (p-values <0.0001). For the study group comparison of hsCRP value pre-operative and post-operatively 6 hours, using Wilcoxon Signed Rank Test has given the p-value <0.001 indicating that the increased hsCRP concentration in patients' circulation is highly significant as a predictor of difficult laparoscopic cholecystectomy. Similarly, Comparison of hsCRP value pre-operative and post-operative 12 hours, using Wilcoxon Signed Rank Test revealed the p-value <0.007 showing it as highly significant and a predictor of difficult LC requiring conversion. The preoperative value of 20.46% is significant for an individual planned for LC who may require conversion. Conclusions:The preoperative hsCRP value of 20.64mg/L, as per our study results, can be relied upon as predictors of difficult LC and/or need for conversion not only in the study group in the given population but also in individual cases. Such a value of 20.64mg/L is definitely important for an individual case management. Knowing the preoperative values beforehand and if found high, it places a surgeon on a cautious note to avoid too much of LC manipulations intra-operatively, take an early decision to go for conversion, reduce the time of surgery, minimise post-operative complications and hence also morbidity.

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Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: A prospective study

Abstract: Male patients of acute cholecystitis or patient with serum C-reactive protein levels of >3.6 mg/dl at admission have high risk of conversion in early laparoscopic cholecystectomy and warrant a conservative early management followed by delayed laparoscopic cholecystectomy.

Cited by 27 publications

References 15 publications

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

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

Risk Factors for Conversion during Laparoscopic Cholecystectomy — Experiences from a General Teaching Hospital

hsCRP levels as predictor of difficult laparoscopic cholecystectomy- current status evaluation experience in a teaching institution

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