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Preoperative systemic and local inflammation are independent risk factors for difficult laparoscopic cholecystectomy
Hai-Hong Wei1,2, Yu-Xiang Wang3, Bin Xu3
1Department of Cardiovascular Surgery, Shanghai Tongren Hospital, Shanghai, China.
Insights
Predicting surgical difficulty in laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage is possible. Elevated inflammation markers and effusion predict challenging cases, aiding surgical planning.
Area of Science:
- Hepatobiliary surgery
- Minimally invasive surgery
- Surgical risk stratification
Background:
- Percutaneous transhepatic gallbladder drainage (PTGBD) is often necessary for acute cholecystitis.
- Laparoscopic cholecystectomy (LC) follows PTGBD, but predicting surgical difficulty remains challenging.
Purpose of the Study:
- To identify predictors of difficult LC in patients who have undergone PTGBD.
- To develop a predictive model for surgical difficulty in this patient cohort.
Main Methods:
- Retrospective analysis of 127 patients undergoing LC after PTGBD (2016-2022).
- Classification of operations into difficult and non-difficult based on operative time, blood loss, and conversion.
- Development and validation of a nomogram using logistic regression and decision curve analysis.
Main Results:
- Elevated C-reactive protein (CRP), pericholecystic effusion, and proximity to the stomach/duodenum were independent risk factors for difficult LC.
- A nomogram incorporating these factors demonstrated good calibration and predictive performance.
- 36 out of 127 patients (28.3%) experienced difficult LC.
Conclusions:
- Preoperative indicators of systemic and local inflammation are valuable predictors of difficult LC after PTGBD.
- The developed nomogram can aid in preoperative risk assessment and surgical planning for these patients.
Background:
Laparoscopic cholecystectomy (LC) is required for acute cholecystitis patient with percutaneous transhepatic gallbladder drainage (PTGBD). However, it's unknown how to distinguishing the surgical difficulty for these patients.
Methods:
Data of patients who underwent LC after PTGBD between 2016 and 2022 were collected. Patients were categorized into difficult and non-difficult operations based on operative time, blood loss, and surgical conversion. Performance of prediction model was evaluated by ROC, calibration, and decision curves.
Results:
A total of 127 patients were analyzed, including 91 in non-difficult operation group and 36 in difficult operation group. Elevated CRP (P = 0.011), pericholecystic effusion (P < 0.001), and contact with stomach or duodenal (P = 0.015) were independent risk factors for difficult LC after PTGBD. A nomogram was developed according to these risk factors, and was well-calibrated and good at distinguishing difficult LC after PTGBD.
Conclusion:
Preoperative elevated systemic and local inflammation indictors are predictors for difficult LC after PTGBD.
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