Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Oncology
• Medical Diagnostics

Background:

• Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis.
• Difficult LC cases, occurring in approximately 1 in 6 patients, present increased risks of vascular and biliary injuries due to inflammation and adhesions.

Purpose of the Study:

• To identify preoperative parameters that predict surgical difficulties in patients undergoing LC for acute cholecystitis.
• To enhance preoperative assessment for optimizing therapeutic decisions and patient safety.

Main Methods:

• Retrospective study of 255 patients with acute cholecystitis between 2019 and 2023.
• Comparison of patient demographics, clinical presentation, laboratory values, and imaging findings between normal LC and difficult LC (DLC) groups.
• Evaluation of the predictive power of the Tongyoo score and a multivariate model.

Main Results:

• Patients in the DLC group had significantly higher complication rates (33.3% vs. 15.3%).
• Preoperative factors associated with DLC included older age, male sex, diabetes, delayed presentation, fever, and positive Murphy sign.
• Elevated total leukocytes, neutrophils, and neutrophil-to-lymphocyte ratio (NLR) were observed in the DLC group.
• The Tongyoo score (AUC 0.856) and a multivariate model (AUC 0.802) demonstrated superior predictive capability for DLC.

Conclusions:

• Preoperative identification of factors predicting difficult laparoscopic cholecystectomy is essential.
• Clinical, laboratory, and scoring systems can aid in predicting surgical difficulty, allowing for better surgical planning and risk mitigation.