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Serrano-González R, Rivero Y, Hernandez-Velasquez A, Rodriguez-Rugel T, Mendez-Meneses G, Vidal-Gallardo A, Garcia-Sánchez E, Gonzalez-Quinde G, Antigua-Herrera J, Zelaya-Ochoa Y, Paz-Castillo M. Predicting Difficulty in Laparoscopic Cholecystectomies: An Evaluation of the Labbad-Vivas Score and Its Correlation With the Parkland Grading Scale. Cureus 2024; 16:e56185. [PMID: 38618440 PMCID: PMC11015945 DOI: 10.7759/cureus.56185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background Difficult laparoscopic cholecystectomy (DLC) denotes the surgical extraction of the gallbladder under circumstances where associated conditions within the same organ, adjacent structures, or patient-specific conditions impede a smooth, expeditious, and comfortable dissection. It is imperative to utilize tools that aid in anticipating this challenging surgical scenario, enabling the implementation of appropriate measures. Objective This study aimed to assess the effectiveness of the Labbad-Vivas score (LVS) in predicting DLC and its correlation with the Parkland Grading Scale (PGS). Methodology A prospective study was conducted, including patients diagnosed with gallstone disease undergoing LC (laparoscopic cholecystectomy) at the "Dr. Luis Razetti" University Hospital in Barcelona, Venezuela, between September and December 2023. Results Forty patients were studied, with 80% (n=32) being female and 95% (n=38) under the age of 65; surgeries were elective in 72.5% (n=29) of cases; 35% (n=14) had an LVS ≥16 (difficult cholecystectomy); and 62.5% (n=25) of patients presented Grades 1 and 2 on the PGS. Total cholecystectomy was performed in 95% (n=38) of the patients. The LVS showed a sensitivity of 80%, specificity of 92%, positive predictive value of 85.7%, and negative predictive value of 88.5% to predict DLC, with an area under the receiver operating characteristic curve of 0.897 (95% confidence interval (CI) = 0.792-1.003). A Pearson correlation coefficient of 0.805 (95% CI = 0.656 - 0.904) was obtained between both scores. Conclusion The use of the LVS score in the preoperative setting is feasible as a predictor of DLC, given its effectiveness and high correlation with the PGS.
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Affiliation(s)
| | - Yeisson Rivero
- Department of Surgery, Universidad de Oriente Núcleo Anzoátegui, Barcelona, VEN
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Anees K, Faizan M, Siddiqui SA, Anees A, Faheem K, Shoaib U. Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy. Surg Innov 2024; 31:26-32. [PMID: 37926929 DOI: 10.1177/15533506231212595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Cholelithiasis is one of the most common diseases encountered in gastroenterology. Laparoscopic cholecystectomy can be labelled as difficult if the surgery continues for more than 60 minutes or if the cystic artery is injured before ligation or clipping. Predicting difficult laparoscopic cholecystectomy can help the surgeon to be prepared for intraoperative challenges such as adhesions in triangle of Calot, injury to cystic artery or gall stone spillage; and improve patient counseling. METHODS In this cross-sectional study, we evaluated 269 patients with diagnosed cholelithiasis and planned for laparoscopic cholecystectomy in the general surgery department of Civil Hospital Karachi. After approval of the institution review board of the Civil Hospital, the data of all the patients was collected along with informed consent. The patients were selected via nonprobability, consecutive sampling. RESULTS The prevalence of difficult LC during procedure was 14.5% (39/269). Contingency table showed the true positive, negative and false positive and negative observation and using these observation to compute accuracy. Sensitivity, specificity, PPV, NPV and accuracy of serum c-reactive protein (CRP) in predicting the difficult laparoscopic cholecystectomy in patients of cholelithiasis was 87.2%, 97%, 82.9%, 97.8% and 95.5% respectively. Effect modifiers like age, gender and BMI were controlled by stratification analysis and observed that diagnostic accuracy was above 90% in all stratified groups as presented in the following tables. 175 (65.06%) of 279 patients were females indicating female predominance. In general, 41 patients (15.05%) had CRP serum levels greater than 11 mg/dL out of which 34 patients had to undergo difficult laparoscopic cholecystectomy (DLC), while 223 out of 228 patients with serum CRP levels of less than 11 mg/dL did not face any difficulty during their cholecystectomy. Similar results have been acquired across all age groups and both genders. CONCLUSION C Reactive Protein is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high C Reactive Protein CRP levels in serum have more chances of complication intraoperatively and increased chances of conversion from laparoscopic to open surgery. Preoperative C Reactive Protein (CRP) with values >11 mg/dL was associated with the highest odds of presenting difficult laparoscopic cholecystectomy (DLC) in our study. This value possesses good sensitivity, specificity, PPV, and NPV for predicting DLC in our population.
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Affiliation(s)
- Khadija Anees
- Department of General Surgery, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Faizan
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ayesha Anees
- dow medical college, Dow University of Health Sciences, Karachi, Pakistan
| | - Komal Faheem
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Umer Shoaib
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
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Serban D, Stoica PL, Dascalu AM, Bratu DG, Cristea BM, Alius C, Motofei I, Tudor C, Tribus LC, Serboiu C, Tudosie MS, Tanasescu D, Vancea G, Costea DO. The Significance of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Inflammatory Index (SII) in Predicting Severity and Adverse Outcomes in Acute Calculous Cholecystitis. J Clin Med 2023; 12:6946. [PMID: 37959411 PMCID: PMC10648653 DOI: 10.3390/jcm12216946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
The prediction of severity in acute calculous cholecystitis (AC) is important in therapeutic management to ensure an early recovery and prevent adverse postoperative events. We analyzed the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) to predict advanced inflammation, the risk for conversion, and postoperative complications in AC. Advanced AC was considered the cases with empyema, gangrene, perforation of the gallbladder, abscesses, or difficulties in achieving the critical view of safety. A 3-year retrospective was performed on 235 patients admitted in emergency care for AC. The NLR was superior to the PLR and SII in predicting advanced inflammation and risk for conversion. The best predictive value was found to be at an NLR "cut-off" value of >4.19, with a sensitivity of 85.5% and a specificity of 66.9% (AUC = 0.824). The NLR, SII, and TG 13/18 correlate well with postoperative complications of Clavien-Dindo grade IV (p < 0.001 for all variables) and sepsis. For predicting early postoperative sepsis, TG 13/18 grading >2 and NLR > 8.54 show the best predicting power (AUC = 0.931; AUC = 0.888, respectively), although not significantly higher than that of the PLR and SII. The NLR is a useful biomarker in assessing the severity of inflammation in AC. The SII and PLR may be useful in the prediction of systemic inflammatory response.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Paul Lorin Stoica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Dan Georgian Bratu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Mihail Silviu Tudosie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania;
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
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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. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:523-527. [PMID: 36130716 DOI: 10.1097/sle.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/31/2022] [Indexed: 12/07/2022]
Abstract
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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Bouassida M, Zribi S, Krimi B, Laamiri G, Mroua B, Slama H, Mighri MM, M'saddak Azzouz M, Hamzaoui L, Touinsi H. C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases. J Gastrointest Surg 2020; 24:2766-2772. [PMID: 31768828 DOI: 10.1007/s11605-019-04459-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels. METHODS This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery. RESULTS On multivariable logistic regression analysis, male gender (OR = 0.4; p = 0.05), diabetes mellitus (OR = 7.8; p = 0.005), 3-4 ASA score (OR = 5.34; p = 0.037), body temperature (OR = 2.65; p = 0.014), and CRP (OR = 1.01; p = 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003-1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion. CONCLUSION CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter-international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.
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Affiliation(s)
- Mahdi Bouassida
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. .,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Slim Zribi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Krimi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ghazi Laamiri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Mroua
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Helmi Slama
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed M'saddak Azzouz
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Lamine Hamzaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Rajab IM, Majerczyk D, Olson ME, Addams JMB, Choe ML, Nelson MS, Potempa LA. C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights. BIOPHYSICS REPORTS 2020. [DOI: 10.1007/s41048-020-00108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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7
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Role of procalcitonin as a predictor in difficult laparoscopic cholecystectomy for acute cholecystitis case: A retrospective study based on the TG18 criteria. Sci Rep 2019; 9:10976. [PMID: 31358829 PMCID: PMC6662745 DOI: 10.1038/s41598-019-47501-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Difficult laparoscopic cholecystectomy (DLC) is difficult to precisely predict before operation. This observational cohort study aimed to evaluate the predictive value of procalcitonin (PCT) for DLC in patients with acute cholecystitis (AC). A total of 115 patients were included in the study from January 2017 to April 2018. Multiple logistic regression and receiver-operating characteristic (ROC) were performed to evaluate the predictive value of PCT levels in DLC. Patients with DLC had significantly higher Tokyo Guidelines 2018 (TG18) grade (P = 0.002) and levels of C-reactive protein (CRP) (P = 0.007) and PCT (P < 0.001). The cut-off value of PCT for predicting DLC was 1.50 ng/ml. The sensitivity and specificity were 91.3% (95% CI 78.3–97.1) and 76.8% (95% CI 64.8–85.8), respectively. The area under ROC curve was 92.7% (95% CI 88.2–97.3, P < 0.001). Our results suggested that PCT was a good predictor for DLC in the AC patients, but further research is necessary. Monitoring of PCT trends in AC patients may be useful for preoperative risk assessment.
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8
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Maitra I, Date AR, Date RS. Cholecystectomy for gallstone pancreatitis should never be difficult. HPB (Oxford) 2019; 21:932. [PMID: 30777698 DOI: 10.1016/j.hpb.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Ishaan Maitra
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, PRC9HT, UK.
| | - Akshay R Date
- Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Vicarage Road, WD18 0HB, UK
| | - Ravindra S Date
- The University of Manchester, Manchester Academic Health Science Centre, Lancashire Teaching Hospital NHS Foundation Trust and the University of Central Lancashire, UK
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Gregory GC, Kuzman M, Sivaraj J, Navarro AP, Cameron IC, Irving G, Gomez D. C-reactive Protein is an Independent Predictor of Difficult Emergency Cholecystectomy. Cureus 2019; 11:e4573. [PMID: 31281756 PMCID: PMC6605972 DOI: 10.7759/cureus.4573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The objective of this study was to identify variables that predict a difficult laparoscopic cholecystectomy performed in an emergency setting. The secondary aim was to devise a pathway for patients admitted acutely that required a cholecystectomy. Methods Patients admitted to the Emergency General Surgery Department at Nottingham, the United Kingdom that had an emergency cholecystectomy performed during the one-year period from May 2016 to June 2017 were identified. Collected data included patient demographics, clinical presentation, biochemical analysis, radiological findings, subsequent interventions, surgical data, and clinical outcome. A difficult cholecystectomy was defined as operative time >60 minutes, conversion to an open procedure, or sub-total cholecystectomy performed. Results A total of 149 patients were included. Cholecystitis was the most common diagnosis (n = 86, 57.7%), followed by acute pancreatitis (n = 36, 24.1%). Fifty-five (36.9%) patients had an elevated C-reactive protein (CRP) >100 mg/dL. One hundred and twenty-one (81.2%) patients who had an emergency cholecystectomy were defined as “difficult”. The overall morbidity rate was 15.4% (n = 23), and there was no post-operative in-hospital mortality. Univariate analysis showed that age >60 years (p = 0.012), underlying diagnosis (p = 0.010), presence of heart rate >90 (p = 0.027), and an elevated pre-surgery CRP >100 (p < 0.001) was associated with a difficult emergency cholecystectomy. Multi-variate analysis demonstrated that an elevated pre-surgery CRP >100 was an independent predictor of a difficult emergency cholecystectomy (p = 0.041). Conclusions An elevated pre-operative CRP is an independent predictor of a technically more difficult cholecystectomy in the emergency setting.
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Affiliation(s)
- Gordon C Gregory
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Matta Kuzman
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Jayaram Sivaraj
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Alex P Navarro
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Iain C Cameron
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Glen Irving
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
| | - Dhanwant Gomez
- Hepato-Pancreato-Biliary Surgery, Nottingham University Hospitals, Nottingham, GBR
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10
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Krishnamohan N, Lo C, Date RS. Predicting the degree of difficulty of laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography- Subgroup analysis does not improve the prediction. J Minim Access Surg 2018; 15:360-361. [PMID: 30416139 PMCID: PMC6839358 DOI: 10.4103/jmas.jmas_190_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nitya Krishnamohan
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Christina Lo
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, United Kingdom
| | - Ravindra S Date
- Department of Upper Gastrointestinal Surgery, Preston PR2 9HT, United Kingdom; Manchester Academic Health Science Centre, The University of Manchester, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, United Kingdom
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11
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Date RS, Gerrard AD. Inflammation and indication: A novel approach to predict degree of difficulty during emergency laparoscopic cholecystectomy. J Minim Access Surg 2018; 14:362-364. [PMID: 29319018 PMCID: PMC6130187 DOI: 10.4103/jmas.jmas_197_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ravindra Sudhachandra Date
- Department of Upper GI Surgery, Lancashire Teaching Hospital NHS Foundation Trust, Chorley PR7 1PP, United Kingdom
| | - Adam D Gerrard
- Department of Upper GI Surgery, Lancashire Teaching Hospital NHS Foundation Trust, Chorley PR7 1PP, United Kingdom
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12
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Díaz-Flores A, Cárdenas-Lailson E, Cuendis-Velázquez A, Rodríguez-Parra A, Trejo-Ávila ME. C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy in Patients with Acute Calculous Cholecystitis: A Multivariate Analysis. J Laparoendosc Adv Surg Tech A 2017. [DOI: 10.1089/lap.2017.0139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Aarón Díaz-Flores
- Department of General and Endoscopic Surgery, Hospital General “Dr. Manuel Gea González,” Mexico City, Mexico
| | - Eduardo Cárdenas-Lailson
- Department of General and Endoscopic Surgery, Hospital General “Dr. Manuel Gea González,” Mexico City, Mexico
| | - Adolfo Cuendis-Velázquez
- Department of General and Endoscopic Surgery, Hospital General “Dr. Manuel Gea González,” Mexico City, Mexico
| | - Andrés Rodríguez-Parra
- Department of General and Endoscopic Surgery, Hospital General “Dr. Manuel Gea González,” Mexico City, Mexico
| | - Mario E. Trejo-Ávila
- Department of General and Endoscopic Surgery, Hospital General “Dr. Manuel Gea González,” Mexico City, Mexico
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