Prediction of difficult laparoscopic cholecystectomy for acute cholecystitis

Maehira, Hiromitsu; Kawasaki, Masayasu; Itoh, Aya; Ogawa, Michio; Mizumura, Naoto; Toyoda, Sho; Okumura, Satoshi; Kameyama, Masao

doi:10.1016/j.jss.2017.05.008

Cited by 31 publications

(40 citation statements)

References 13 publications

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“…Existing grading methods for the difficulty of LC mainly use surrogate markers such as the risk of conversion to an open operation, a prolonged operative time or post‐operative complications . These outcomes, although partly related to the intra‐operative findings, are also dependent on the skills and preferences of the surgeon, or on institutional protocols regarding conversion, and the availability of experienced peri‐operative staff and equipment .…”

Section: Discussionmentioning

confidence: 99%

“…Existing grading methods for the difficulty of LC mainly use surrogate markers such as the risk of conversion to an open operation, a prolonged operative time or post-operative complications. [13][14][15][16][17][18] These outcomes, although partly related to the intra-operative findings, are also dependent on the skills and preferences of the surgeon, or on institutional protocols regarding conversion, and the availability of experienced peri-operative staff and equipment. 11,19,21 Several groups have suggested from retrospective series that a pre-operative diagnosis or grading of AC according to the TG18 criteria alone is often not helpful in predicting the difficulty of a subsequent LC.…”

Section: Discussionmentioning

confidence: 99%

“…This would assist timing of the procedure and allocation of appropriate resources including the provision of experienced nursing and surgical staff. Numerous groups have attempted this using surrogate markers of difficulty such as the duration of the operation or the need for conversion to open cholecystectomy . However, these outcomes are highly dependent on surgeons' experience and institutional preferences …”

Section: Introductionmentioning

confidence: 99%

“…Numerous groups have attempted this using surrogate markers of difficulty such as the duration of the operation or the need for conversion to open cholecystectomy. [13][14][15][16][17][18] However, these outcomes are highly dependent on surgeons' experience and institutional preferences. 19 The aim of the current study was to assess the intra-operative findings at LC using a simplified and easily applicable grading system in patients with acute biliary presentations, and to establish an accurate pre-operative prediction model for difficulty of LC.…”

Section: Introductionmentioning

confidence: 99%

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Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

Wennmacker

Bhimani

Dijk

et al. 2019

ANZ Journal of Surgery

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BackgroundEarly laparoscopic cholecystectomy (LC) is advocated in patients with an acute biliary presentation but may require some precaution. We aimed to assess the intra‐operative difficulty of cholecystectomy in patients who underwent early intervention, and to establish a prediction model for a ‘complicated’ LC.MethodsRetrospective analysis of prospectively collected data from patients presenting to the emergency department with acute biliary symptoms, and who subsequently underwent early LC between 2015 and 2018. Operative difficulty was assessed by standardized grading of intra‐operative findings (grades 1–4). Pre‐operative predictors for a ‘complicated’ LC (grades 3/4) were assessed using univariable and multivariable logistic regression analysis. A prediction model was created using variable regression coefficients. Cut‐off and accuracy of the model were assessed using a receiver operating characteristic curve.ResultsA total of 185 patients were included and 59% presented with acute cholecystitis. In this cohort 113 (61%) patients underwent a ‘complicated’ LC. A prediction model for a ’complicated’ LC (0–4.5 points) included: clinical diagnosis of acute cholecystitis (2 points), C‐reactive protein >10.5 mg/L (1.5 points) and pericholecystic fluid on pre‐operative imaging (1 point). A score ≥2.5 had a sensitivity of 77.7%, specificity of 81.7% and positive and negative predictive values of 87.0% and 69.9%, respectively.ConclusionEarly LC may be ‘complicated’ in up to 60% of cases. The presented prediction model uses readily available information in the emergency department and is a simple but accurate way to predict a likely ‘complicated’ LC in patients with acute biliary presentations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

Wennmacker

Bhimani

Dijk

et al. 2019

ANZ Journal of Surgery

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“…This is one of the most frequently performed surgical procedures, but still represents a potential cause of serious post-operative complications. In literature, cholecystectomies are considered “difficult” when one, some or all the following characteristics are present: conversion from LC to open cholecystectomy, operating time (180 min), blood loss (300 ml) and efficacious haemostasis of the gallbladder bed, main bile duct injuries or of the cystic artery and the need to immediately summon another surgeon to the operating room [ 2 ]. Currently, the conversion rate is between 4.8 and 8% [ 3 , 4 ] while the incidence of peri- and post-operative VLC complications is about 5–15% [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study

Carbotta

Panebianco

Laforgia

et al. 2018

Annals of Medicine and Surgery

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BackgroundThe gold standard treatment of symptomatic cholelithiasis is videolaparoscopic cholecystectomy (VLC). The aim of this study is to produce a predictive clinical ultrasound (US) score for difficult VLC to reduce the rate of conversion to open cholecystectomy surgery and intra and/or post-operative complications.MethodsIn this prospective study carried out in 2017 we enrolled 135 patients (pts) who underwent VLC in our General Surgery Unit. A specific pre-operative abdominal ultrasound scan was performed to assess gallbladder characteristics for each patient. All US and patients' characteristics were recorded in a standard form in order to obtain a preoperative score and were then added to the intra-operative variables.ResultsThe analysis revealed a statistical significance between post-operative characteristics and parietal thickness, adhesions, stratifications and volume of gallstones. Comparing the degree of difficulty VLC assessed in the pre-operative stage to the intraoperative score, the sensitivity of the preoperative US scan test is 91.8% while the specificity is 76.7%.ConclusionsThe variables which proved statistically significant in predicting a difficult cholecystectomy were: age, parietal thickness >3 mm, adhesions, stratifications, gallstones >2 cm and fixed gallstones. We have definitively defined a predictive score for difficult VLC for which a VLC is to be considered potentially difficult whenever it presents a pre-operative score equal or greater than 4 (and a "easy" one with a pre-operative score less than 4). These findings may prove helpful in further reducing the conversion rate and the rate of intra- and/or post-operative complications.

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Impact of transient hepatic attenuation differences on computed tomography scans in the diagnosis of acute gangrenous cholecystitis

Uemura

Higuchi

Yazawa

et al. 2019

J Hepato Biliary Pancreat

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BackgroundWe examined the utility of transient hepatic attenuation differences (THADs) detected in the arterial phase of computed tomography for the diagnosis of acute gangrenous cholecystitis (AGC).MethodsWe examined 83 consecutive patients who underwent cholecystectomy within 72 h of undergoing three‐phase dynamic computed tomography scans for acute cholecystitis between 2009 and 2018 (histopathological examination later confirmed 42 with AGC, 41 without). The THAD volume (cm3) was calculated by multiplying the total area of the enhancing lesions (traced on axial images) by the thickness of the scan (0.5‐cm slices). We evaluated the sensitivity and specificity of the THAD volume and other computed tomography findings of AGC.ResultsThe THAD volume was significantly larger in the AGC group than in the non‐gangrenous acute cholecystitis group (P < 0.0001). The cutoff value of 78 cm3, determined using a receiver operating characteristics curve, yielded a sensitivity of 88.1% and specificity of 75.6% for detecting AGC. Multivariate analysis revealed a THAD volume of >78 cm3 to be an independent predictor of AGC.ConclusionsAcute gangrenous cholecystitis can be diagnosed using THAD volume, resulting in improved treatment and fewer serious complications.

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Prediction of difficult laparoscopic cholecystectomy for acute cholecystitis

Cited by 31 publications

References 13 publications

Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study

Impact of transient hepatic attenuation differences on computed tomography scans in the diagnosis of acute gangrenous cholecystitis

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