Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder

Sakuramoto, Shinichi; Satō, Shigeru; Okuri, Takehiko; Sato, Koshi; Hiki, Yoshiki; Kakita, Akira

doi:10.1016/s0002-9610(00)00248-8

Cited by 48 publications

(57 citation statements)

References 18 publications

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“…The compiled statistical analysis failed to define predictors unequivocally. A considerable thickening of the gallbladder wall, impeded orientation in cirrhotic changes, gallstone disease in men over 65, and palpable gallbladder mass on physical examination were found to be the most frequent causes of conversion [1, 15, 21, 24, 34]. Additional significant reasons for conversion to OCH include intraperitoneal adhesions, obscured anatomy, obesity, old age, male gender, persistent fever, and ultrasound findings of acute cholecystitis [5, 11, 15, 17–19, 31, 33].…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of the laparoscopic approach include a shorter hospital stay and recovery time, reduced postoperative pain, and better cosmetic results [1–6]. The role of LCH in the treatment of complicated gallstone disease, and particularly acute cholecystitis, is still controversial and has been a subject of vigorous debate [2, 7–9].…”

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confidence: 99%

“…Many publications pointed out that age over 60–65, previous upper abdominal surgery, clinical and ultrasound signs of severe acute cholecystitis at admission, and white blood count (WBC) >10.0 k/μL were significantly associated with conversion to open cholecystectomy (OCH) [1, 2, 5, 15]. Recently, an increasing number of reports have indicated that LCH is a safe method of treatment for acute cholecystitis, especially due to the improvement in surgical technique and instrumentation.…”

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confidence: 99%

“…Recently, an increasing number of reports have indicated that LCH is a safe method of treatment for acute cholecystitis, especially due to the improvement in surgical technique and instrumentation. The established limitations for use of LCH include the operating surgeon’s experience and the degree of inflammation, especially in seriously complicated cases [1, 2, 7, 13, 16]. Patients with acute cholecystitis are usually informed of the potential for conversion to open cholecystectomy when it is difficult to identify the main anatomic structures [5, 17, 18].…”

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The value of percutaneous ultrasound in predicting conversion from laparoscopic to open cholecystectomy due to acute cholecystitis

et al. 2013

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BackgroundLaparoscopic cholecystectomy has become the treatment of choice for gallstone disease. Advantages of the laparoscopic approach include lower morbidity and mortality rates, reduced length of hospital stay, and earlier return to work. In acute cholecystitis, severe inflammation makes laparoscopic dissection technically more demanding, with a higher risk of related complications that require conversion to open cholecystectomy.MethodsWe reviewed the records of 5,596 patients who underwent cholecystectomy between 1993 and 2011 in a single institution. A laparoscopic approach was undertaken in 4,105 patients (73.4 %). The ultrasound signs of acute cholecystitis were found in 542 patients (13.2 %) who underwent laparoscopic cholecystectomy. We analyzed the ultrasound presentations of acute cholecystitis in patients who required conversion to open cholecystectomy and compared them with the ultrasound signs of acute cholecystitis in patients who had a completed laparoscopic cholecystectomy.ResultsA conversion to open cholecystectomy in patients with acute cholecystitis was necessary in 24 % (n = 130) of the patients compared to 3.4 % of the patients with uncomplicated gallstone disease. The most frequent ultrasound findings in patients requiring conversion were a pericholecystic exudate in 42 %, a difficult identification of anatomical structures due to local severe inflammation in 34 %, and gallbladder wall thickening of >5 mm in 31 %. Additionally, when the duration of symptoms exceeded 3 days, more than half of the patients required conversion to open cholecystectomy and the conversion rate was fivefold higher than for those with a shorter duration of acute cholecystitis.ConclusionsIn patients with severe acute cholecystitis found on ultrasound, combined with gallbladder wall thickening to >5 mm, pericholecystic exudates or abscess adjacent to the gallbladder, difficulty identifying anatomical structures within Calot’s triangle, specifically when the duration of symptoms exceeds 3 days, cholecystectomy should be done as an open approach because of the high risk of conversion.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The value of percutaneous ultrasound in predicting conversion from laparoscopic to open cholecystectomy due to acute cholecystitis

et al. 2013

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“…Evidence for factors that might contribute to surgical difficulty during LC are ambiguous despite several existing studies (preoperative radiological findings [4][5][6], the optimal timing for LC [3,7], indications of preoperative interventions such as percutaneous transhepatic gallbladder drainage [8,9], etc). Most of the previous publications have adopted either the duration of surgery [4][5][6] or open conversion rate [10][11][12][13][14] as surrogate markers for surgical difficulty. However, these factors are strongly affected by the skill of each surgeon and center's policy.…”

Section: Introductionmentioning

confidence: 99%

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

Iwashita

Hibi

Ohyama

et al. 2017

J Hepatobiliary Pancreat Sci

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Background We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. Methods Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median AE 1 after stratification by workplace and LC experience level. Results Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. Conclusions A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

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Preoperative MRI for predicting pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis

et al. 2020

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Background: Severe inflammation with necrosis and fibrosis of the gallbladder in acute cholecystitis increases operative difficulty during laparoscopic cholecystectomy. This study aimed to assess the use of preoperative MRI in predicting pathological changes of the gallbladder associated with surgical difficulty. Methods: Patients who underwent both preoperative MRI and early cholecystectomy for acute cholecystitis between 2012 and 2018 were identified retrospectively. On the basis of the layered pattern of the gallbladder wall on MRI, patients were classified into three groups: high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI). The endpoint was the presence of pathological changes of the gallbladder associated with surgical difficulty, such as necrosis, abscess formation and fibrosis. Results: Of 229 eligible patients, pathological changes associated with surgical difficulty were found in 17 (27 per cent) of 62 patients in the HSI group, 84 (85 per cent) of 99 patients in the ISI group, and 66 (97 per cent) of 68 patients in the LSI group (P < 0⋅001). For detecting these changes, intermediate to low signal intensity of the gallbladder wall had a sensitivity of 90 (95 per cent c.i. 84 to 94) per cent, specificity of 73 (60 to 83) per cent and accuracy of 85 (80 to 90) per cent. Conclusion: Preoperative MRI predicted pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis.

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Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder

Cited by 48 publications

References 18 publications

The value of percutaneous ultrasound in predicting conversion from laparoscopic to open cholecystectomy due to acute cholecystitis

The value of percutaneous ultrasound in predicting conversion from laparoscopic to open cholecystectomy due to acute cholecystitis

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

Preoperative MRI for predicting pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis

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