To Study the Level of High-Sensitive C-Reactive Protein With Ultrasonographic Findings as a Predictive Factor for Difficult Laparoscopic Cholecystectomy

Abstract

BACKGROUND Laparoscopic cholecystectomy is considered to be the gold standard for the treatment of gallstones. However, conversion of laparoscopic cholecystectomy to open cholecystectomy is done by surgeons in difficult cases. The aim of the study is to use Hs-CRP level in correlation with ultrasonographic findings to predict difficult laparoscopic cholecystectomy pre-operatively. It would help in anticipating a difficult laparoscopic cholecystectomy pre-operatively, better counselling of patients, avoiding unnecessary laparoscopic dissection and hence less morbidity. MATERIALS AND METHODS This is an observational study. It is an original study conducted in the Department of General Surgery of Gauhati Medical College and Hospital. The study group included 40 consecutive patients undergoing laparoscopic cholecystectomy for cholelithiasis. Cholelithiasis was diagnosed on the basis of ultrasonography done pre-operatively. Hs-CRP level was determined pre-operatively and post-operatively after 6 hrs. and 12 hrs. It was correlated with ultrasonographic findings to predict difficult cholecystectomy. RESULTS The mean value of Hs-CRP was found to be 9.68 mg/L pre-operatively, 21.88 mg/L at 6 hours and 26.57 mg/L at 12 hours. While the mean value of Hs-CRP was found to be significantly higher in cases, which needed conversion. USG findings such as presence of adhesion, GB wall thickness more than 3 mm and narrow Calot's triangle were found to be significant predictors for conversion. On correlation, the positive predictive value increased. CONCLUSION Pre-operative values of Hs-CRP when combined with ultrasonography findings can predict difficult cholecystectomy. It will help in better selection of patients and help in decreasing morbidity.