Laparoscopic cholecystectomy for acute cholecystitis: Can the need for conversion and the probability of complications be predicted?
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Background: Laparoscopic cholecystectomy (LC) in acute cholecystitis is associated with a relatively high rate of conversion to an open procedure as well as a high rate of complications. The aim of this study was to analyze prospectively whether the need to convert and the probability of complications is predictable.
Methods: A total of 215 patients undergoing LC for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their predictive power.
Results: Conversion was indicated in 44 patients (20.5%), and complications occurred in 36 patients (17%). Male gender and age >60 years were associated with conversion, but these factors had no sensitivity and no positive predictive value. The same factors, together with a disease duration of >96 h, a nonpalpable gallbladder, a white blood count (WBC) of >18,000/cc3, and advanced cholecystitis, predicted conversion with a sensitivity of 74%, a specificity of 86%, a positive predictive value of ∼40%, and a negative predictive value of 96%. However, these data became available only when LC was underway. Male gender and a temperature of >38°C were associated with complications, but these factors had no sensitivity and no positive predictive value. Progression along the stages of admission and therapy did not add predictive factors or improve the predictive characteristics. Male gender, abdominal scar, bilirubin >1 mg%, advanced cholecystitis, and conversion to open cholecystectomy were associated with infectious complications. Their sensitivity and positive predictive value remained 0 despite progression along the stages of admission and therapy.
Conclusion: Although certain preoperative factors are associated with the need to convert a LC for acute cholecystitis, they have limited predictive power. Factors with higher predictive power are obtained only during LC. The need to convert can only be established during an attempt at LC. Preoperative and operative factors associated with total and infectious complications have no predictive power.
- Chahin F, Elias N, Paramesh A, Saba A, Godziachvili V, Silva YJ (1999) The efficacy of laparoscopy in acute cholecystitis. J Soc Laparoendosc Surg 3: 121–125
- Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RTA, Toouli J (1993) Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 218: 630–634 CrossRef
- Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21: 540–545 CrossRef
- Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, Hinchey EJ, Meakins JL (1994) Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 167: 35–39 CrossRef
- Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11: 347–350 CrossRef
- Hashizume M, Sugimachi K, MacFadyen BV (1998) The clinical management and results of surgery for acute cholecystitis. Semin Laparosc Surg 5: 69–80
- Koo KP, Thirlby RC (1996) Laparoscopic cholecystectomy in acute cholecystitis: what is the optimal timing for operation? Arch Surg 131: 540–544
- Koperna T, Kisser M, Schulz F (1999) Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 46: 753–757
- Kum CK, Goh PMY, Isaac JR, Tekant Y, Ngoi SS (1994) Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81: 1651–1654 CrossRef
- Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85: 764–767 CrossRef
- Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227: 461–467 CrossRef
- Lo CM, Liu CL, Lai EC, Fan ST, Wong J (1996) Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg 223: 37–42 CrossRef
- Lujan JA, Parrilla P, Robles R, Torralba JA, Garcia Ayllon J, Liron R, Sanchez-Bueno F (1995) Laparoscopic cholecystectomy in the treatment of acute cholecystitis. J Am Coll Surg 181: 75–77
- Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64: 955–957
- Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217: 233–236 CrossRef
- Sanabria JR, Gallinger S, Croxford R, Strasberg SM (1994) Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg 179: 696–704
- Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60: 326–328
- Willsher PC, Sanabria JR, Gallinger S, Rossi L, Strasberg S, Litwin DE (1999) Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure. J Gastrointest Surg 3: 50–53 CrossRef
- Zucker KA, Bailey RW, Flowers J (1992) Laparoscopic management of acute and chronic cholecystitis. Surg Clin North Am 72: 1045–1067
- Zucker KA, Flowers JL, Baily RW, Graham SM, Buell J, Imbembo AL (1993) Laparoscopic management of acute cholecystitis. Am J Surg 165: 508–514 CrossRef
- Laparoscopic cholecystectomy for acute cholecystitis: Can the need for conversion and the probability of complications be predicted?
Volume 14, Issue 8 , pp 755-760
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- 1. Department of Surgery, Bnai Zion Medical Center, the Faculty of Medicine, and the Faculty of Industrial Engineering and Management, the Technion, Israel institute of Technology, 47 Golomb Street, Post Office Box 4940, 31048, Haifa, Israel