Risk Factors of Difficult Laparoscopic Cholecystectomy for Acute Cholecystitis in Acute Care Surgery Patients
Seehawong U, MD1, Sumritpradit P, MD1, Krutsri C, MD1, Singhatat P, MD1, Thampongsa T, MD1, Tangtawee P, MD2
Affiliation : 1 Division of Trauma and Surgical Critical Care, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 2 Division of Hepatopancreatobiliary Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Laparoscopic cholecystectomy (LC) now is considered as a treatment of choice for the management of acute
cholecystitis (AC) around the world. Conversion rates of LC in urgency or emergency setting has increased.
Objective : The present study aimed to identify risk factors signifying difficulty during performing LC for acute cholecystitis in acute
care patients.
Materials and Methods : Electronic Medical Records (EMR) of 103 acute cholecystitis patients in Acute Care Surgery service in
Ramathibodi Hospital, between 1 January and 31 December 2017, were reviewed. Thirty-eight patients who underwent urgency
LC were enrolled and divided into difficult LC and not-difficult LC groups. Pre-operative characteristics and postoperative outcomes
were analyzed.
Results : From 38 cases, 35 cases were in the not-difficult group and 3 cases were in the difficult group. Age, severe inflammation
at Hartmann pouch, and intra-operative findings of gangrene gallbladder were risk factors for difficult LC’s that met statistical
significance, p-value = 0.023, 0.026, and 0.025, respectively.
Conclusion : From the present study, risk factors for difficult LC’s in urgency acute cholecystitis is age, severe inflammation of
Hartmann’s pouch, and intra-operative findings of gangrene gallbladder. The reason why we have only 3 difficult LC cases from a
total of 38 LC cases is due to pre-operative ultrasound findings of gallbladder wall necrosis and old age. They are the significant
factors that make the surgeon’s decision to do OC first. Intra-operative findings of OC are GB necrosis according to pre-operative
ultrasound, also.
Keywords : LC, Acute care surgery, Difficult LC
