Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Abstract

BackgroundThe purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified.MethodsA total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used.ResultsLaparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications.ConclusionsAdvanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0111-4) contains supplementary material, which is available to authorized users.

Acute cholecystitis in patients with diabetes mellitus - systematic review

“…In 19 of the analyzed articles, diabetes was discussed as an independent risk factor for acute cholecystitis and in 14 of them diabetes was confirmed as an independent risk factor for developing this disease [1, [8][9][10][11][12][13][14][15][16][17][18][19]. Two studies analyzed this correlation in detail and in one it was significant only for women (p < 0,001), while in another it was significant only for men (p < 0,001) [20][21].…”

“…On the other hand, one paper reported that diabetes increases the frequency of bleeding during surgery [27]. The authors of 3 papers reported that pre-operative gallbladder perforation occurs substantially more frequently to patients with diabetes [9,27,32]. In 3 studies no difference in the duration of surgery in patients with diabetes was noted, however in one of these studies it was demonstrated that the duration of anesthesia in patients with diabetes is significantly longer [26][27]32].…”

Acute Abdomen in Diabetic Patients - What Should We Do?

“…In several studies, age over 65 years, diabetes and CRP over 150 mg/l were identified as independent preoperative risk factors for conversion. Complications of severe inflammation like gangrene of the gallbladder and an abscess identified by the surgeon (and which are not rare in diabetic patients) were also recognized as risk factors in the multivariate analysis examining both preoperative and intraoperative findings (13,14).…”

Risk Factors of Postoperative Complications in Laparoscopic Cholecystectomy for Acute Cholecystitis

“… 23 , 24 Several studies also mentioned that the age, gender, comorbidity, BMI, presence of a fever, and conversion to open cholecystectomy were independent risk factors for postoperative complications in LC. 8 , 9 , 25 , 26 As described in these studies and TG18, the assessment of the patient’s general condition, which enables the prediction of the potential for postoperative complications, was very important for the perioperative management in LC.…”