Abstract text (incl. references and figure legends)
Introduction Early intended laparoscopic cholecystectomy (LC) has been suggested as the standard treatment of acute cholecystitis if patients do not have other significant medical underlying conditions. Conversion to open cholecystectomy from intended laparoscopic LC or laparoscopic subtotal cholecystectomy may be encountered in the scenario. We aimed to identify the predictive factors for these difficult situations.
Material & Methods From January 2011 to February 2021, we reviewed the reports of abdominal computed tomography (CT) done at the emergency department of our institute. Initial treatment of acute cholecystitis, and clinical information, including demographic and laboratory data, upper abdomen operation history, and image parameters, were extracted from medical records. Patients who underwent early intended LC at the same hospitalization were enrolled for analysis. Conversion to open surgery and subtotal cholecystectomy were defined as difficult cholecystectomy.
Results Of 1603 patients with acute cholecystitis, 593 underwent early intended LC, and 24 were difficult cholecystectomies. For patients of difficult cholecystectomy, male (p = 0.005), higher body mass index (BMI) (p = 0.004), diabetes mellitus (DM) (p = 0.007), previous upper abdomen operation history (p = 0.004), and cases combined with cholangitis (p <0.001) were significantly higher compared to patients underwent LC. As for preoperative laboratory data, higher abnormal liver function (AST, p = 0.03, ALT, p = 0.023, TB, p = 0.013) as well as higher CRP level (p <0.001) were observed in the difficult cholecystectomy group. Operation delays greater than 72 hours were also significantly higher in patients of the difficult cholecystectomy group.
Conclusions Patients with higher BMI, DM, previous upper abdomen operation history, abnormal hepatic function, higher CRP level, and conditions combined with cholangitis have the potential risk of experiencing difficult cholecystectomy.
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