Publication: Risk factors of difficult laparoscopic cholecystectomy for acute cholecystitis in acute care surgery patients
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Issued Date
2019-02-01
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01252208
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2-s2.0-85068593718
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol.102, No.2 (2019), S56-S60
Suggested Citation
U. Seehawong, P. Sumritpradit, C. Krutsri, P. Singhatat, T. Thampongsa, P. Tangtawee Risk factors of difficult laparoscopic cholecystectomy for acute cholecystitis in acute care surgery patients. Journal of the Medical Association of Thailand. Vol.102, No.2 (2019), S56-S60. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/51892
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Title
Risk factors of difficult laparoscopic cholecystectomy for acute cholecystitis in acute care surgery patients
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Abstract
© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019. 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.