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

World Journal of Emergency Surgery, Nov 2016

Background The 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. Methods A 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. Results Laparoscopic 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. Conclusions Advanced 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.

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

Terho et al. World Journal of Emergency Surgery Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications Petra Maria Terho 1 Ari Kalevi Leppäniemi 0 Panu Juhani Mentula 0 0 Department of Abdominal Surgery, Helsinki University Central Hospital , P.O.Box 340, 00029 HUS Helsinki , Finland 1 Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki , Haartmaninkatu 8, 00014 Helsinki , Finland Background: The 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. Methods: A 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. Results: Laparoscopic 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. Conclusions: Advanced 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. Acute cholecystitis; Laparoscopic cholecystectomy; Open cholecystectomy; Conversion - Background Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis [1, 2]. LC has been linked to a lower complication rate and shorter postoperative hospital stay compared with open cholecystectomy (OC) [3, 4]. Performing early cholecystectomy on patients admitted for acute cholecystitis is preferable to postponing the operation to be performed when the acute phase is over, since an early procedure has been recognized to shorten postoperative hospital stay and lower hospital care expenses [5, 6]. Gallbladder disease is among the leading causes for hospital admission for acute abdomen among adults and the most common indication for abdominal surgery in the elderly [7, 8]. In situations when LC is unsafe the surgeon might have to convert to an open procedure. The risk of conversion is higher in LC for acute cholecystitis than it is in an elective procedure [9]. The risk of conversion for patients undergoing LC for acute cholecystitis has been linked to male gender, age, previous endoscopic retrograde cholangiopancreatography (ERCP), a non-palpable gallbladder, elevated C-reactive protein (CRP) and white blood cell count (WBCC), gangrenous inflammation and the © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. experience of the operating surgeon [10–13]. Conservative treatment with antibiotics and delaying the procedure to be performed after the acute phase has shown no change in conversion and complication rates [5, 14]. Patients who have had to undergo conversion have had more complications, which have led to further operations and a longer postoperative hospital stay [10]. Accounting for risk factors for conversion and complications is important when planning the procedure and deciding on whom to assign to perform the cholecystectomy. Experienced surgeons have been shown to have a lower complication rate for LC compared with surgeons in training [11]. Informing the patient about the procedure and the risk of complications is likewise important. The aim of this study was to identify risk factors associated with conversion in patients with acute calculous cholecystitis. The risk factors for postoperative complications and the most common complications were also to be identified. Methods P (...truncated)


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Petra Terho, Ari Leppäniemi, Panu Mentula. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications, World Journal of Emergency Surgery, 2016, pp. 54, 11, DOI: 10.1186/s13017-016-0111-4