Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: a prospective study.
BACKGROUND
Early laparoscopic cholecystectomy has become the treatment of choice for acute cholecystitis. However, the rate of intraoperative conversion to open surgery remains high and has provoked an interest in studying the predictive factors for better patient selection to minimize the conversion rates.


METHODS
50 patients of acute cholecystitis were operated within 5 days of onset of symptoms. Comparative evaluation of the patient groups undergoing successful versus failed early laparoscopic cholecystectomy was done to identify preoperative factors predicting conversion/failure of the laparoscopic procedure. Predictive factors for intraoperative and histopathological severity of acute cholecystitis were also identified.


RESULTS
40 patients underwent successful completion of early laparoscopic cholecystectomy, 8 required conversions to open, while in 2 patients the procedure had to be abandoned due to phlegmon formation. Male sex, preoperative duration of symptoms WBC counts, serum alkaline phosphatase, serum amylase, and serum C-reactive protein were significant predictors of histopathological severity of acute cholecystitis. Intraoperative and histopathological severity of acute cholecystitis had good association with conversion rate of early laparoscopic cholecystectomy. Male sex and serum C-reactive protein levels >3.6 mg/dl at admission were very strong predictors of conversion/failure of early laparoscopic cholecystectomy in acute cholecystitis.


CONCLUSIONS
Male patients of acute cholecystitis or patient with serum C-reactive protein levels of >3.6 mg/dl at admission have high risk of conversion in early laparoscopic cholecystectomy and warrant a conservative early management followed by delayed laparoscopic cholecystectomy.
Teckchandani
Narinder
N
Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Garg
Pankaj Kumar
PK
Hadke
Niladhar S
NS
Jain
Sudhir Kumar
SK
Kant
Ravi
R
Mandal
A K
AK
Bhalla
Preena
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000681:Amylases / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000601:surgery*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D002097:C-Reactive Protein; D000469:Alkaline Phosphatase; D000681:Amylases