Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis.
OBJECTIVE
Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors.


METHODS
One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S).


RESULTS
In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%;P= .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P= .034 andP= .004).


CONCLUSIONS
In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.
Department of Surgery.
Satoshi
S
Hayama
Department of Surgery.
Kazuto
K
Ohtaka
Department of Surgery.
Yasuhito
Y
Shoji
Department of Surgery.
Tatsunosuke
T
Ichimura
Department of Pathology, Steel Memorial Muroran Hospital, Hokkaido, Japan.
Miri
M
Fujita
Department of Surgery.
Naoto
N
Senmaru
Department of Gastroenterology Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Satoshi
S
Hirano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Acute cholecystitis; Difficult laparoscopic cholecystectomy; Histopathologic necrotizing cholecystitis; Laparoscopic cholecystectomy; Operative timing