Retrospective Analysis of the Factors Affecting the Risk and Difficulty of the Laparoscopic Surgery for Acute Cholecystitis

Koetsu Inoue¹, Tatsuya Ueno¹, Orie Suzuki¹, Masanobu Hayashi¹, Kentarou Shima¹, Ryouichi Anzai¹, Shinji Gotou¹, Michinaga Takahashi¹, Takanori Morikawa², Takeshi Naitoh², Hiroo Naitoh¹. ¹South Miyagi Medical Center, Department of Surgery, ²Tohoku University Graduate School of Medicine, Department of Surgery

INTRODUCTION: According to the Tokyo guidelines, cholecystitis is classified into three categories (Grade I, II, III) depending on its severity. The guideline recommends some therapeutic options for each categories. The guideline notes early laparoscopic cholecystectomy (LC) or gallbladder drainage (PTGBD) is required for grade II cholecystitis. The aim of this study is to evaluate the risk factors for the difficulty of the LC in the Grade II cholecystitis.

PATIENTS AND METHODS: Medical records since 2010 to 2015, were retrospectively reviewed. A total of 98 Grade II cholecystitis patients who underwent LC were enrolled in this study, including patients converted to open surgery. The patients were divided into two groups: difficult LC group and non-difficult group. The difficult LC was defined as 1. Operation time > 180 minutes and/or 2. Blood loss > 300 ml. Preoperative characteristics and postoperative outcomes were analyzed. Comparisons of paired data were analyzed by two-tailed Student’s t test and/or Pearson’s chi-square test. Statistical analyses were performed using JMP Pro 11 software (SAS Institute).

RESULTS: A univariate analysis revealed the duration of symptoms was a risk factor of the difficulty (difficult LC group vs non-difficult LC group, 64.0 vs 31.3 hrs). The incidence of postoperative complications was significantly higher in a difficult LC group compared with non-difficult LC group (25.0 vs 6.8 %). Postoperative hospital stay was also significantly longer in the non-difficult group (9.0 vs 6.0 days). When looking at relation between postoperative complications and the duration of symptoms, cut off value of the duration of symptoms was 96 hrs according to ROC curve. Incidences of postoperative complications in patients who received the treatment within 96hrs and over 96hrs, were 8.0% and 40.0%, respectively.

CONCLUSION: In the patients who have longer duration from its onset, laparoscopic surgery for acute cholecystitis would be difficult and would have the higher risk of complications.