The role of C-reactive protein as a predictor of difficult laparoscopic cholecystectomy or its conversion

Abstract

Background: Laparoscopic cholecystectomy (LC) can be the easiest or the most difficult laparoscopic operation. Conversion to open surgery has been a traditional marker of difficult LC. Recent studies have shown that C-reactive protein (CRP) may be helpful to surgeon in knowing the pathological condition of gall bladder before removal. Aim of this study was to evaluate the role of CRP as a predictor of difficult LC or its conversion.Methods: This study was done from 1 march 2016 to may 2017 in department of general surgery, SMS hospital Jaipur, under single unit. All patients with cholelithiasis admitted in single unit of SMS hospital undergoing LC were included in this study. Exclusion criteria were high BMI (>35), proven congenital anomaly of gall bladder, previous abdominal surgery, any conditions increasing CRP and immunocompromised patients. CRP was done for each patient.Results: Mean age of our 148 patients was 50.41 years. Female to male ratio was 4.28:1. Mean CRP was 22.2±18.2 mg/dl for simple cholecystectomy, 46.5±32.0 mg/dl for difficult cholecystectomy and 83.6±22.4 mg/dl for laparoscopic converted to open cholecystectomy, which was statistically significant (p value 0.0002).Conclusions: CRP is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high CRP have higher chance of complication intraoperative and high chances of conversion to open.

The Nassar Scale as an Instrument for Predicting Conversionof Laparoscopic to Open Cholecystectomy

“…Emergency patients had significantly higher Nassar grades compared to patients undergoing elective surgery. While no studies comparing Nassar grade levels based on the type of surgical indication for cholecystectomy were found, previous research indicated a potential connection between complications during laparoscopic cholecystectomy and variations in C-reactive protein (CRP) levels, with notable discrepancies in CRP values and conversion criteria across different studies1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . While our study did not specifically investigate the relationship between CRP levels and conversion, this aspect warrants attention in future research to understand better how CRP may be linked to the Nassar scale.…”

Acute cholecystitis: Delayed cholecystectomy has lesser perioperative morbidity compared to emergency cholecystectomy

“…This further supports the benefit of performing a delayed laparoscopic cholecystectomy after a "cooling off" period. 22,23 The readmission risk before DLC is significant (13.5% over 2 months; 22.5% over the median waiting time [5 months, 9 days]) and must be minimized. Recurrent admissions ultimately result in increased morbidity that may actually outweigh the benefit of DLC.…”

Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy

“…1 Laparoscopic cholecystectomy (LC) is the gold standard procedure for cholecystectomy in patients with gall stones. 2 Difficult laparoscopic cholecystectomy (DLC) is faced in about 2-7% cases of laparoscopic cholecystectomy procedures. 3 Different definitions exist, but the conversion rate and iatrogenic injuries are considered frequently as indicators of a difficult procedure.…”

“…4 Previous studies have identified predictors for Difficult laparoscopic cholecystectomy, these predictors are as follows: male sex, advanced age, acute and chronic cholecystitis, obesity, liver cirrhosis and surgical experience whereas laboratory parameters as leucocyte count and c-reactive protein. 2 There are some existing scales that evaluate the risk of conversion from laparoscopic to open surgery, [6][7][8] but few scales that predict Difficult laparoscopic cholecystectomy. 9 C-reactive protein (CRP) is one identified as predictor of such complications.…”

“…1 Laparoscopic cholecystectomy (LC) is the gold standard procedure for cholecystectomy in patients with gall stones. 2 Difficult laparoscopic cholecystectomy (DLC) is faced in about 2-7% cases of laparoscopic cholecystectomy procedures. 3…”