Identification of risk factors for open conversion from laparoscopic cholecystectomy for acute cholecystitis based on computed tomography findings.

Abstract

PURPOSE:

Laparoscopic cholecystectomy (LC) is performed widely for acute cholecystitis (AC). This study was conducted to identify the predictors for conversion cholecystectomy (CC) for AC.

METHODS:

The subjects of this study were 395 patients who underwent emergency surgery for AC between 2011 and 2019. Univariate and multivariate analyses were performed to establish the significance of the risk factors for CC in patients with grades II and III AC.

RESULTS:

There were 162 TG18 GII and GIII patients in the LC group and 31 in the CC group. Univariate analysis revealed significant differences in performance status (p = 0.039), C-reactive protein levels (p = 0.016), albumin levels (p = 0.002), gallbladder (GB) wall thickness (p = 0.045), poor contrast of the GB wall (p = 0.035), severe inflammation around the GB (p < 0.001), enhancement of the liver bed (p = 0.048), and duodenal edema (p < 0.001) between the groups. Multivariate analysis identified hypoalbuminemia (p = 0.043) and duodenal edema (p = 0.014) as independent risk factors for CC.

CONCLUSIONS:

Most patients with grade I AC underwent LC and had better surgical outcomes than those with grades II and III AC. The most appropriate surgical procedure should be selected based on preoperative imaging of the GB and the neighboring organs and by the presence of hypoalbuminemia.

• Authors: Ryosuke Hirohata, Tomoyuki Abe, Hironobu Amano, Keiji Hanada, Tsuyoshi Kobayashi, Hideki Ohdan, Toshio Noriyuki, Masahiro Nakahara
• Journal: Surgery today (Surg Today) Vol. 50 Issue 12 Pg. 1657-1663 (Dec 2020) ISSN: 1436-2813 [Electronic] Japan
• PMID: 32627066 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Serum Albumin
• C-Reactive Protein

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• C-Reactive Protein
• Cholecystectomy (methods)
• Cholecystectomy, Laparoscopic (methods)
• Cholecystitis, Acute (diagnosis, pathology, surgery)
• Conversion to Open Surgery (statistics & numerical data)
• Female
• Gallbladder (pathology)
• Humans
• Hypoalbuminemia
• Male
• Risk Factors
• Serum Albumin
• Severity of Illness Index
• Tomography, X-Ray Computed
• Treatment Outcome