Risk factors of difficult laparoscopic cholecystectomy for acute cholecystitis in acute care surgery patients

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.