THE PREDICTIVE VALUE OF C-REACTIVE PROTEIN (CRP) AS A MARKER FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY OR ITS CONVERSION
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Keywords
C-reactive protein, laparoscopic cholecystectomy, open surgery
Abstract
Background: For the majority of patients with gallbladder problems, laparoscopic cholecystectomy (LC) is the recommended operation since it is associated with less pain and a quicker return to regular activities than open cholecystectomy. Laparoscopic cholecystectomy can be easy or difficult, and conversion to open surgery is frequently seen as an indication of a difficult treatment (2–7%). The exact ratio of when to choose an open treatment versus how long a surgeon should continue with a laparoscopic procedure is not well defined. When a laparoscopic cholecystectomy is performed for more than two hours, perioperative problems are four times more likely to occur than during 30- to 60-minute procedures.
Objective: To evaluate the predictive value of CRP in identifying laparoscopic cholecystectomy complications or the necessity of switching to an open operation.
Study design: A cross-sectional study
Place and Duration: This study was conducted at XXX Hospital from June 2022 to June 2023.
Methodology: This study encompassed all individuals with cholelithiasis who were admitted to a specific hospital unit and underwent laparoscopic cholecystectomy. For all the participants, CRP was done. Patients with a proven congenital anomaly of gallbladder, any other situation increasing CRP, a high BMI (>35), or previous abdominal surgery were not included in this research. Moreover, immunocompromised patients were also excluded. SPSS version 26 was used for statistical analysis.
Results: There were a total of 180 people involved in this research. The mean age of the patients was 50.41 years. There were a total of 146 females and 34 males. The most common complaint was pain in the abdomen, which was present in 97.2% of participants. A total of 132 patients had simple cholecystectomy, 39 had difficult cholecystectomy, and 9 converted to open cholecystectomy. The level of CRP increased with the increase in difficulty of dissection.
Conclusion: According to the current research, preoperative CRP levels are a reliable indicator of potential difficulties during laparoscopic cholecystectomy as well as the possibility of an open surgery being necessary.
References
2. Jessica Mok K, Goh Y, Howell L. Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study. Journal of Minimal Access Surgery. 2015.
3. Mok KW, Goh YL, Howell LE, Date RS. Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study. Journal of Minimal Access Surgery. 2016 Jan;12(1):26.
4. Ng HJ, Ahmed Z, Khan KS, Katbeh T, Nassar AH. C-reactive protein level as a predictor of difficult emergency laparoscopic cholecystectomy. BJS open. 2019 Oct;3(5):641-5.
5. Elhady HA, Esmail TA. Is C-reactive Protein an Independent Risk Factor for Complication of Laparoscopic Cholecystectomy for Acute Cholecystitis. Journal of Surgery. 2017;5(3-1):16-22.
6. Kohli R, Bansal E, Gupta AK, Matreja PS, Kaur K. To study the levels of C-reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy. Journal of clinical and diagnostic research: JCDR. 2014 Jun;8(6):NC06.
7. Halevy A, Lin G, Gold-Deutsch R, Lavi R, Negri M, Evans S, Cotariu D, Sackier JM. Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surgical endoscopy. 1995 Mar;9:280-2.
8. Gregory GC, Kuzman M, Sivaraj J, Navarro AP, Cameron IC, Irving G, Gomez D. C-reactive protein is an independent predictor of difficult emergency cholecystectomy. Cureus. 2019 Apr 30;11(4).
9. Díaz-Flores A, Cárdenas-Lailson E, Cuendis-Velázquez A, Rodríguez-Parra A, Trejo-Avila ME. C-reactive protein as a predictor of difficult laparoscopic cholecystectomy in patients with acute calculous cholecystitis: a multivariate analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2017 Dec 1;27(12):1263-8.
10. Godre P, Krishnanand DS. An observational study of pre-operative predictors of difficult laparoscopic cholecystectomy using clinical, haematological, radiological parameters. Int J Contemp Med Surg Radiol. 2022;7(2):B8-14.
11. Assaff Y, Matter I, Sabo E, Mogilner JG, Nash E, Abrahamson J, et al. Laparoscopic cholecystectomy for acute cholecystitis and the consequences of gallbladder perforation, bile spillage, and “loss” of stones. Eur J Surg. 1998;164:425-31
12. Liu CL, Fan ST, Lai EC, Lo CM, Chu KM. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 1996;131:98-101.
13. Bansal AR, Arora V, Dangi A, Godara R. Evaluation of early versus interval laparoscopic cholecystectomy in acute calculus cholecystitis. Hellenic J Surg. 2015;87:224.
14. Mok KW, Reddy R, Wood F, Turner P, Ward JB, Pursnani KG et al. Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe gangrenous cholecystitis? IJS. 2014;12(7):649.
15. Asai K, Watanabe M, Kusachi S, Tanaka H, Matsukiyo H, Osawa A, et al. Bacteriological analysis of bile in acute cholecystitis according to The Tokyo guidelines. J Hepato-Biliary pancreat Sci. 2012;19(4):476.
16. Andrei MB, Michael B. C-reactive protein measurement is not associated with an improved management of acute cholecystitis: a pile for change. JSR. 2015;198: 93.
17. Díaz-Flores A, Cárdenas-Lailson E, CuendisVelázquez A, Rodríguez-Parra A, Trejo-Avila ME. C-Reactive protein as a predictor of difficult laparoscopic cholecystectomy in patients with acute calculous cholecystitis: a multivariate analysis. J Laparoendosc Adv Surg Tech. 2017 Dec 1;27(12):1263-8.
18. Gurbulak EK, Gurbulak B, Akgun IE, Duzkoylu Y, Battal M, Celayir MF et al. Prediction of the gradeof acute cholecystitis by plasma level of C-reactive protein. IRC Med. 2015;17(4):28091.
19. Atta J, Yousfani ZA, Lashari NA, Memon HNA, Das T, Baloch ZAQ. C-reactive protein in patients with preeclampsia. IAJPS. 2017; 4: 520-523.
20. Gholipur C, Fakree MB, Shalchi RA, Abbasim. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural network. BMC Surg. 2009;9:13.
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Zubair Ahmed Yousfani
Associate Professor General Surgery, Liaquat University of Medical and Health Sciences Jamshoro.
Jabeen Atta
Associate Professor Gynecology and obstetrics, BMC Liaquat University of Medical and Health Sciences Jamshoro
Khenpal Das
Assistant professor General Surgery, Liaquat University of Medical and Health Sciences Jamshoro.
Muhammad Hanzala Yousfani
2nd year MBBS Student Liaquat University of Medical and Health Sciences Jamshoro
Ghulamullah Rind
Assistant Professor General Surgery, Liaquat University of Medical and Health Sciences Jamshoro.
Maria Memon
Consultant General Surgeon, Liaquat University of Medical and Health Sciences Jamshoro.