Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis
Abstract
:1. Introduction
2. Materials and Methods
3. Results
Preoperative Prediction of Difficult LC
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Non-Difficult LC Group (N = 150) | Difficult LC Group (N = 105) | p-Value |
---|---|---|---|
Age (mean ± SD, years) | 52.4 (±16.2) | 57.1 (±14.2) | 0.009 * |
Sex M (n, %) W (n, %) | 41 (27.3%) 109 (72.6%) | 43 (40.9%) 62 (59%) | 0.03 * |
BMI > 25 (n,%) | 66 (44%) | 57 (54.2%) | NS |
Previous upper abdominal surgery (n,%) | 9 (6%) | 7 (6.6%) | NS |
Diabetes mellitus (n,%) | 17 (11.3%) | 24 (22.8%) | 0.02 * |
ASA risk grading (n,%) I II III IV V | 10 (6.6%) 86 (57.3%) 46 (30.6%) 7 (4.6%) 1 (0.6%) | 3 (2.8%) 54 (51.4%) 42 (40%) 5 (4.7%) 1 (0.9%) | NS |
Onset > 72 h (n, %) | 63 (42%) | 59 (56.1%) | 0.03 * |
Fever (n,%) | 4 (2.6%) | 13 (12.3%) | 0.004 * |
Jaundice (n, %) | 17 (11.3%) | 17 (16.1%) | NS |
Murphy sign positive (n, %) | 92 (61.3%) | 82 (78.1%) | 0.007 * |
Leukocytes (cells/µL) (mean ± SD) | 9622.5 (±4170.5) | 12,731.6 (±7216.8) | <0.001 * |
Leukocytes > 16,000/µL (mean ± SD) | 7 (4.6%) | 21 (20%) | <0.001 * |
Neutrophils (cells/µL) (mean ± SD) | 6639.5 (±1347.1) | 9637.3 (±1527.7) | 0.001 * |
Lymphocytes (%) (mean ± SD) | 1924.5 (±1.154.7) | 2087.8 (±1489.5) | 0.002 * |
NLR (mean ± SD) | 6.2 (±7.8) | 11 (±25) | 0.001 * |
Thrombocytes (µL) (mean ± SD) | 247,622.6 (±81,254.2) | 264,731.4 (±174,673.6) | NS |
Fibrinogen (mg/dL) (mean ± SD) | 409.8 (±127.3) | 574.5 (±238.7) | <0.001 * |
INR (UI/L) (mean ± SD) | 1.2 (±0.3) | 1.3 (±1.2) | NS |
AST (UI/L) (mean ± SD) | 54.6 (±86.4) | 57.5 (±99.9) | NS |
ALT (UI/L) (mean ± SD) | 74.8 (±90.6) | 70.8 (±89.4) | NS |
Total Bilirubin (mg/dL) (mean ± SD) | 1.0 (±1.3) | 1.2 (±1.8) | NS |
Creatinine (mg/dL) (mean ± SD) | 0.8 (±0.3) | 0.9 (±0.4) | NS |
TG13/TG18 Grading of AC I II III | 81 (54%) 55 (36.6%) 14 (9.3%) | 28 (26.6%) 48 (45.7%) 29 (27.6%) | <0.001 * |
ERCP (pre/postoperative) | 7 (4.6%) | 9 (8.5%) | NS |
Tongyoo score | 2.9 ± 1.4 | 6.0 ± 2.6 | <0.001 * |
Variable | Normal LC (N = 150) | Difficult LC (N = 105) | p-Value |
---|---|---|---|
CBD (mm) (mean ± SD) | 5 (±2.2) | 5 (±2) | NS |
Dilatation of intrahepatic bile ducts (n, %) | 12 (8%) | 7 (6.6%) | NS |
Transverse diameter of GB (mm) (mean ± SD) | 28.7 (±7.9) | 36.4 (±12.3) | <0.001 * |
Length of GB (mm) (mean ± SD) | 79.4 (±18.6) | 93.3 (±27.1) | <0.001 * |
Thickness of GB wall (mm) (mean ± SD) | 4.2 (±1.5) | 6 (±2.8) | <0.001 * |
GB wall > 5 mm (n, %) | 49 (32.6%) | 74 (70.4%) | <0.001 * |
The double contour of the GB wall (n, %) | 27 (18%) | 51 (48.5%) | <0.001 * |
Types of GB lithiasis (n, %): GB stones Microlithiasis Sludge | 109 (72.6%) 44 (29.3%) 18 (12%) | 73 (69.5%) 32 (30.4%) 26 (24.7%) | NS NS 0.01 * |
CBD lithiasis (n, %) | 7 (4.6%) | 3 (2.8%) | NS |
Pericholecystic fluid (n, %) | 4 (2.6%) | 23 (21.9%) | <0.001 * |
Ultrasound MURPHY sign + (n, %) | 4 (2.6%) | 14 (13.3%) | 0.002 * |
Variable | Normal LC N = 150 | Difficult LC N = 105 | p-Value |
---|---|---|---|
Surgery type (n, %): LC Conversion to OC | 150 (100%) 0 (0%) | 81 (77.1%) 24 (22.8%) | <0.001 * |
Mean operation time (min, mean ± SD) | 101.5 ± 43.6 | 213 ± 163.4 | <0.001 * |
Mean blood loss (mL, mean ± SD) | 38.7 ± 43.1 | 273.4 ± 354.7 | <0.001 * |
Associated ERCP (pre/postoperative) (n, %) | 7 (4.6%) | 8 (7.6%) | NS |
Total hospital stay (days, mean ± SD) | 6.4 (±4.1) | 8.1 (±4.1) | <0.001 * |
Postoperative hospital stay (days, mean ± SD) | 2.8 (±2.3) | 4.3 (±2.7) | <0.001 * |
Postoperative complications (n, %) | 23 (15.3%) | 35 (33.3%) | <0.001 * |
• Bile leak | 1 (0.6%) | 3 (2.8%) | |
• Main BDI | 1 (0.6%) | 2 (1.9%) | |
• Hemorrhage | 3 (2%) | 6 (5.7%) | |
• Intestinal injury | 1 (0.6%) | 0 | |
• SSI | 1 (0.6%) | 7 (5.7%) | |
• Pleuro-pulmonary (pneumonia, pleural effusion) | 3 (2%) | 3 (2.8%) | |
• Cardiovascular (malign hypertension, hypotension, hemodynamic instability) | 5 (3.3%) | 4 (3.8%) | |
• Nosocomial infections | 5 (3.3%) | 6 (5.7%) | |
• Others (upper gastrointestinal hemorrhage, anaphylactic shock, acute limb ischemia, acute pancreatitis) | 3 (2%) | 4 (3.8%) | |
Death (n, %) | 2 (1.3%) | 1 (0.9%) | NS |
Postoperative Complications | Normal LC | Difficult LC | p-Value |
---|---|---|---|
Grade 1 (SSI) | 1 (0.6%) | 7 (6.6%) | 0.006 * |
Grade 2 (surgery-related complications, treated pharmacologically) | 4 (2.6%) | 8 (7.6%) | 0.03 * |
Grade 3 (surgery-related complications requiring surgical, endoscopic, and radiological treatment) | 1 (0.6%) | 6 (5.7%) | 0.01 * |
Grade 4 (general complications, requiring intensive care) | 8 (5.3%) | 9 (8.5%) | NS |
Grade 5 (death) | 2 (1.3%) | 1 (0.9%) | NS |
Odds Ratio | p-Value | |
---|---|---|
Intercept | ||
0.00624 [0.00153; 0.0254] | <0.0001 **** | |
Fibrinogen | ||
Risk for each 1-unit increase | 1.004 [1.002; 1.005] | 0.00207 ** |
Transverse diameter of gallbladder | ||
Risk for each 1-unit increase | 1.05 [1.02; 1.08] | 0.00393 ** |
Thickness of gallbladder wall | ||
Risk for each 1-unit increase | 1.4 [1.18; 1.67] | 1.38 ×10−4 *** |
Parameter | AUC | Cut-Off Value | Sensitivity | Specificity | Positive Predictive Value | Negative Predictive Value |
---|---|---|---|---|---|---|
Tongyoo score | 0.857 | >4 | 67.6% | 88% | 79.7% | 79.3% |
Regression model | 0.802 | >0.5 | 60.5% | 86.6% | 75.7% | 75.6% |
Fibrinogen (serum) | 0.701 | >536 | 53.3% | 86.7% | 73.5% | 72.7% |
NLR | 0.634 | >6.33 | 49.5% | 77.3% | 60.2% | 68.7% |
GB wall thickness | 0.734 | >4.7 | 70.5% | 67.3% | 59.9% | 76.6% |
TG 13/18 | 0.659 | >1 | 72.3% | 53.3% | 51.8% | 73.4% |
L > 16,000 | 0.577 | >0 | 20.0% | 95.3% | 73.5% | 63.1% |
Total Leukocytes | 0.663 | >13,200 | 38.1% | 85.3% | 63.3% | 66.4% |
Pericholecystic fluid | 0.596 | >0 | 21.9% | 97.33% | 84.9% | 64.1% |
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Stoica, P.L.; Serban, D.; Bratu, D.G.; Serboiu, C.S.; Costea, D.O.; Tribus, L.C.; Alius, C.; Dumitrescu, D.; Dascalu, A.M.; Tudor, C.; et al. Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis. Diagnostics 2024, 14, 346. https://doi.org/10.3390/diagnostics14030346
Stoica PL, Serban D, Bratu DG, Serboiu CS, Costea DO, Tribus LC, Alius C, Dumitrescu D, Dascalu AM, Tudor C, et al. Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis. Diagnostics. 2024; 14(3):346. https://doi.org/10.3390/diagnostics14030346
Chicago/Turabian StyleStoica, Paul Lorin, Dragos Serban, Dan Georgian Bratu, Crenguta Sorina Serboiu, Daniel Ovidiu Costea, Laura Carina Tribus, Catalin Alius, Dan Dumitrescu, Ana Maria Dascalu, Corneliu Tudor, and et al. 2024. "Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis" Diagnostics 14, no. 3: 346. https://doi.org/10.3390/diagnostics14030346