Predictors of Prolonged Laparoscopic Cholecystectomy in the Treatment of Low-grade Acute Cholecystitis: a Single-center, Retrospective, Observational Study

Overview

Journal Acute Med Surg

Specialty Critical Care

Date 2017 Nov 11

PMID 29123719

Authors

Tadashi Kaneko

Taichi Kuwahara

Toshio Harada

Toru Kawaoka

Sakurao Hiraki

Shintaro Fukuda

Affiliations

Soon will be listed here.

Abstract

Aim: Laparoscopic cholecystectomy is frequently used to treat low-grade acute cholecystitis. Improvements in technical skills have reduced the rate of conversion from laparoscopic to open surgery. In this study, we sought to identify factors that might predict the surgical time of laparoscopic cholecystectomy as possible markers for surgical difficulty.

Methods: We carried out a single-center retrospective analysis of a Japanese medical insurance database. Data were retrieved for 87 patients with acute cholecystitis. The analyzed factors included age, sex, body mass index, medical history, blood laboratory data, computed tomography findings, and time from disease onset to surgery. Multiple regression analysis was used to identify factors associated with surgical time.

Results: Edema of the gallbladder wall on computed tomography, neutrophil sequestration, body mass index, and history of acute cholangitis were significantly associated with surgical time ( = 0.014, 0.027, 0.043, and 0.047, respectively). The conversion rate from laparoscopic surgery to open surgery was 2%.

Conclusions: Our results suggest that edema of the gallbladder wall on computed tomography, neutrophil sequestration, body mass index, and history of acute cholangitis are associated with surgical time of laparoscopic cholecystectomy in the treatment of acute cholecystitis in our hospital.

References

Dindo D, Muller M, Weber M, Clavien P . Obesity in general elective surgery. Lancet. 2003; 361(9374):2032-5. DOI: 10.1016/S0140-6736(03)13640-9. View

Navez B, Ungureanu F, Michiels M, Claeys D, Muysoms F, Hubert C . Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surg Endosc. 2012; 26(9):2436-45. DOI: 10.1007/s00464-012-2206-7. View

Meng F, Tsao M, Huang M, Huang H . Laparoscopic cholecystectomy techniques with special care treatment in acute cholecystitis patients regardless of operation timing. Hepatogastroenterology. 2012; 59(116):1006-9. DOI: 10.5754/hge10188. View

Koo K, Thirlby R . Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation?. Arch Surg. 1996; 131(5):540-4; discussion 544-5. DOI: 10.1001/archsurg.1996.01430170086016. View

Fuks D, Mouly C, Robert B, Hajji H, Yzet T, Regimbeau J . Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy. Radiology. 2012; 263(1):128-38. DOI: 10.1148/radiol.12110460. View

Wu J, Wu Y, Lee C, Wang H, Lin M . Is early laparoscopic cholecystectomy a safe procedure in patients when the duration of acute cholecystitis is more than three days?. Hepatogastroenterology. 2012; 59(113):10-2. DOI: 10.5754/hge10040. View

Kortram K, van Ramshorst B, Bollen T, Besselink M, Gouma D, Karsten T . Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials. 2012; 13:7. PMC: 3285056. DOI: 10.1186/1745-6215-13-7. View

Kim I, Kim J, Jeon J, Jung J, Chon S, Kim H . Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis. J Laparoendosc Adv Surg Tech A. 2011; 21(10):941-6. DOI: 10.1089/lap.2011.0217. View

Han I, Jang J, Kang M, Lee K, Lee S, Kim S . Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage. J Hepatobiliary Pancreat Sci. 2011; 19(2):187-93. DOI: 10.1007/s00534-011-0458-6. View

10.

Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K . Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14(1):78-82. PMC: 2784516. DOI: 10.1007/s00534-006-1159-4. View

11.

Abi-Haidar Y, Sanchez V, Williams S, Itani K . Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg. 2012; 147(5):416-22. DOI: 10.1001/archsurg.2012.135. View

12.

Banz V, Gsponer T, Candinas D, Guller U . Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg. 2011; 254(6):964-70. DOI: 10.1097/SLA.0b013e318228d31c. View

13.

Donkervoort S, Dijksman L, de Nes L, Versluis P, Derksen J, Gerhards M . Outcome of laparoscopic cholecystectomy conversion: is the surgeon's selection needed?. Surg Endosc. 2012; 26(8):2360-6. DOI: 10.1007/s00464-012-2189-4. View

14.

Eldar S, Sabo E, Nash E, ABRAHAMSON J, Matter I . Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997; 21(5):540-5. DOI: 10.1007/pl00012283. View

15.

Brook O, Kane R, Tyagi G, Siewert B, Kruskal J . Lessons learned from quality assurance: errors in the diagnosis of acute cholecystitis on ultrasound and CT. AJR Am J Roentgenol. 2011; 196(3):597-604. DOI: 10.2214/AJR.10.5170. View