Preoperative scoring system validation and analysis of associated risk factors in predicting difficult laparoscopic cholecystectomy in patients with acute calculous cholecystitis: A prospective observational study

Abstract

Objective: Today laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the presence of severe inflammation makes it challenging for the surgeons to accurately recognize the Calot’s triangle which increases the risk of intraoperative complications. The aim of this study was to explore the validity of a scoring system used to predict difficult LC and to analyse the risk factors associated with difficult cholecystectomy in the setting of acute calculous cholecystitis. Material and Methods: An observational study was conducted between December 2018 and December 2020 among 132 patients diagnosed with acute cholecystitis, who underwent laparoscopic cholecystectomy. A scoring system by Randhawa et al. was used preoperatively for all of these patients to predict difficult LC, which was correlated to intraoperative difficulties in actual surgery. Data were analysed using the SPSS version 26.0. Results: Mean age was 43.63 ± 13.37, with almost equal representation from both sexes. History of previous attacks of cholecystitis, impacted stone, thickness of GB wall were statistically significant in calculating preoperative difficulty of laparoscopic cholecystectomy. The scoring system had a sensitivity and specificity of 82.6% and 63.5%, respectively. The conversion rate to open cholecystectomy was 6.9%. Conclusion: Analysing the significant risk factors before operating in the presence of an inflamed gallbladder can reduce the overall mortality and morbidity. An accurate preoperative scoring system will enable the operating surgeon to be well prepared with adequate resources and time. The patient attenders can also be counselled regarding the risk involved beforehand.

The Significance of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Inflammatory Index (SII) in Predicting Severity and Adverse Outcomes in Acute Calculous Cholecystitis

“…Predicting the severity of acute cholecystitis is important to achieve the best therapeutic outcomes and prevent adverse postoperative events [2,[26][27][28][29]. Local inflammation and surgical trauma induce metabolic and systemic inflammatory responses, which may lead to systemic complications [30]. Understanding and addressing inflammation and the possible systemic imbalances that it may cause is important to prevent adverse outcomes and unnecessarily prolonged hospital stays in cases with AC.…”

“…Commonly used for diagnosis, CT and ultrasound examination may not accurately predict advanced AC [30,31]. In a study on 1115 patients who underwent surgery for acute calculous cholecystitis, Goiayev et al [31] found that even in cases with a gallbladder wall of ≤ 4.85 mm, if the NLR > 5.65 and the total leukocytes exceed 8100/mm 3 , there is a 92% probability of complicated AC, including gangrenous, perforated, emphysematous, or necrotizing AC.…”

“…In a study on 1115 patients who underwent surgery for acute calculous cholecystitis, Goiayev et al [31] found that even in cases with a gallbladder wall of ≤ 4.85 mm, if the NLR > 5.65 and the total leukocytes exceed 8100/mm 3 , there is a 92% probability of complicated AC, including gangrenous, perforated, emphysematous, or necrotizing AC. NLR is a cheap, easy-to-calculate inflammatory biomarker that combines the relative ratio of neutrophils-the first line of cellular defense in acute inflammationand the lymphocytes, with an immunomodulatory role [30].…”

“…Although several studies have found a significant correlation between the NLR and the severity of inflammation in AC [30,[32][33][34], there is limited evidence regarding the specific cut-off value, with possible clinical use.…”

A prospective study of various pre-operative factors and the development of a scoring system in predicting difficult laparoscopic cholecystectomy

“…2,3 The complexity of LC is influenced by multiple patientrelated factors, including but not limited to, the history of previous abdominal surgeries, the patient's body mass index (BMI), the presence of acute or chronic inflammation, and specific gallbladder (GB) anatomical variations. 4 These factors can increase the risk of complications such as bile duct injury (BDI) or the need for conversion to OC, impacting the patient's recovery trajectory and overall outcome. 5 Given this context, there has been significant interest in developing pre-operative scoring systems to categorize the anticipated difficulty of LC.…”