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Anees K, Faizan M, Siddiqui SA, Anees A, Faheem K, Shoaib U. Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy. Surg Innov 2024; 31:26-32. [PMID: 37926929 DOI: 10.1177/15533506231212595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Cholelithiasis is one of the most common diseases encountered in gastroenterology. Laparoscopic cholecystectomy can be labelled as difficult if the surgery continues for more than 60 minutes or if the cystic artery is injured before ligation or clipping. Predicting difficult laparoscopic cholecystectomy can help the surgeon to be prepared for intraoperative challenges such as adhesions in triangle of Calot, injury to cystic artery or gall stone spillage; and improve patient counseling. METHODS In this cross-sectional study, we evaluated 269 patients with diagnosed cholelithiasis and planned for laparoscopic cholecystectomy in the general surgery department of Civil Hospital Karachi. After approval of the institution review board of the Civil Hospital, the data of all the patients was collected along with informed consent. The patients were selected via nonprobability, consecutive sampling. RESULTS The prevalence of difficult LC during procedure was 14.5% (39/269). Contingency table showed the true positive, negative and false positive and negative observation and using these observation to compute accuracy. Sensitivity, specificity, PPV, NPV and accuracy of serum c-reactive protein (CRP) in predicting the difficult laparoscopic cholecystectomy in patients of cholelithiasis was 87.2%, 97%, 82.9%, 97.8% and 95.5% respectively. Effect modifiers like age, gender and BMI were controlled by stratification analysis and observed that diagnostic accuracy was above 90% in all stratified groups as presented in the following tables. 175 (65.06%) of 279 patients were females indicating female predominance. In general, 41 patients (15.05%) had CRP serum levels greater than 11 mg/dL out of which 34 patients had to undergo difficult laparoscopic cholecystectomy (DLC), while 223 out of 228 patients with serum CRP levels of less than 11 mg/dL did not face any difficulty during their cholecystectomy. Similar results have been acquired across all age groups and both genders. CONCLUSION C Reactive Protein is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high C Reactive Protein CRP levels in serum have more chances of complication intraoperatively and increased chances of conversion from laparoscopic to open surgery. Preoperative C Reactive Protein (CRP) with values >11 mg/dL was associated with the highest odds of presenting difficult laparoscopic cholecystectomy (DLC) in our study. This value possesses good sensitivity, specificity, PPV, and NPV for predicting DLC in our population.
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Affiliation(s)
- Khadija Anees
- Department of General Surgery, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Faizan
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ayesha Anees
- dow medical college, Dow University of Health Sciences, Karachi, Pakistan
| | - Komal Faheem
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
| | - Umer Shoaib
- Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
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Serban D, Stoica PL, Dascalu AM, Bratu DG, Cristea BM, Alius C, Motofei I, Tudor C, Tribus LC, Serboiu C, Tudosie MS, Tanasescu D, Vancea G, Costea DO. The Significance of Preoperative Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Inflammatory Index (SII) in Predicting Severity and Adverse Outcomes in Acute Calculous Cholecystitis. J Clin Med 2023; 12:6946. [PMID: 37959411 PMCID: PMC10648653 DOI: 10.3390/jcm12216946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
The prediction of severity in acute calculous cholecystitis (AC) is important in therapeutic management to ensure an early recovery and prevent adverse postoperative events. We analyzed the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) to predict advanced inflammation, the risk for conversion, and postoperative complications in AC. Advanced AC was considered the cases with empyema, gangrene, perforation of the gallbladder, abscesses, or difficulties in achieving the critical view of safety. A 3-year retrospective was performed on 235 patients admitted in emergency care for AC. The NLR was superior to the PLR and SII in predicting advanced inflammation and risk for conversion. The best predictive value was found to be at an NLR "cut-off" value of >4.19, with a sensitivity of 85.5% and a specificity of 66.9% (AUC = 0.824). The NLR, SII, and TG 13/18 correlate well with postoperative complications of Clavien-Dindo grade IV (p < 0.001 for all variables) and sepsis. For predicting early postoperative sepsis, TG 13/18 grading >2 and NLR > 8.54 show the best predicting power (AUC = 0.931; AUC = 0.888, respectively), although not significantly higher than that of the PLR and SII. The NLR is a useful biomarker in assessing the severity of inflammation in AC. The SII and PLR may be useful in the prediction of systemic inflammatory response.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Paul Lorin Stoica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Dan Georgian Bratu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Mihail Silviu Tudosie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania;
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (D.S.); (B.M.C.); (C.A.); (I.M.); (C.S.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
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Utsumi M, Sakurai Y, Narusaka T, Tokunaga N, Kitada K, Hamano R, Tsunemitsu Y, Miyasou H, Otsuka S, Inagaki M. C-reactive protein to albumin ratio predicts difficult laparoscopic cholecystectomy in patients with acute cholecystitis diagnosed according to the Tokyo Guidelines 2018. Asian J Endosc Surg 2022; 15:487-494. [PMID: 35137536 DOI: 10.1111/ases.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/06/2022] [Accepted: 01/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Difficult laparoscopic cholecystectomy (DLC) may increase the risk of complications and extend the duration of hospitalization. The aims of this study were to evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for DLC in patients with acute cholecystitis (AC) diagnosed according to the Tokyo Guidelines 2018 and to develop a preoperative predictive model for DLC. METHODS We retrospectively analyzed 205 patients who had laparoscopic cholecystectomy for AC between January 2012 and December 2020. We defined DLC cases as having one of the following factors: blood loss ≥50 mL, operative time ≥150 minutes, or conversion to open surgery. We classified the remaining cases into the non-DLC group. RESULTS Overall, 127 (62.0%) and 78 (38.0%) patients were grouped into the DLC and non-DLC groups, respectively. Patients in the DLC group had: higher severity grade, which was assessed using the Tokyo Guidelines 2018; higher incidence of postoperative complications; and more hospitalization days than those in the non-DLC group. Multivariate analysis revealed that male, CAR (≥3.20), and pericholecystic fat hyperdensity on computed tomography (CT) were independent predictors of DLC. We developed a predictive scoring system for DLC based on these three factors (cutoff value, 2.0; area under the curve, 0.75; sensitivity, 71.7%; and specificity, 70.5%). CONCLUSION CAR could predict DLC independently in AC patients. We identified male gender, CAR, and pericholecystic fat hyperdensity on CT as predictive factors for DLC and established a preoperative prediction system based on these three factors.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Yuya Sakurai
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Toru Narusaka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Koji Kitada
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Ryosuke Hamano
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Hideaki Miyasou
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Shinya Otsuka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Masaru Inagaki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
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FIRAT N, OZDEMIR K, MANTOGLU B, MUHTAROGLU A, ELMAS B, YAZAR H, ALTINTOPRAK F. The place of thiol/disulfide homeostasis parameters in acute gallstone cholecystitis diagnosis. Chirurgia (Bucur) 2022; 35. [DOI: 10.23736/s0394-9508.21.05267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2025]
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Lucocq J, Patil P, Scollay J. Acute cholecystitis: Delayed cholecystectomy has lesser perioperative morbidity compared to emergency cholecystectomy. Surgery 2022; 172:16-22. [PMID: 35461704 DOI: 10.1016/j.surg.2022.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In comparison to delayed laparoscopic cholecystectomy, emergency laparoscopic cholecystectomy has a shorter length of stay and eliminates the risk of recurrent episodes of acute cholecystitis. Nevertheless, there is concern that emergency laparoscopic cholecystectomy is associated with higher morbidity in acute cholecystitis patients. The present large cohort study compares operation-related adverse outcomes between emergency and delayed laparoscopic cholecystectomy and determines the risk of readmission before delayed laparoscopic cholecystectomy to guide surgical decision-making. METHODS Patients diagnosed with acute cholecystitis who underwent emergency or delayed laparoscopic cholecystectomy between 2015 and 2019 were included. Perioperative outcomes were compared using univariate and multivariate analysis, adjusting for preoperative variables. The rate of readmission before delayed laparoscopic cholecystectomy was determined. RESULTS In total, 811 patients were included (median age, 58 years; male:female, 1:1.5): 227 emergency laparoscopic cholecystectomies (28.0%), 555 delayed laparoscopic cholecystectomies (68.4%), and 29 emergency laparoscopic cholecystectomies whilst awaiting delayed laparoscopic cholecystectomy (3.6%). Emergency laparoscopic cholecystectomy was associated with increased incidences of subtotal cholecystectomy (OR 1.94; P = .011), bile leak (OR 2.38; P = .013), intraoperative drains (OR 2.54; P < .001), prolonged postoperative length of stay (OR 7.26; P < .001), postoperative imaging (OR 1.83, P = .006), and postoperative readmission (OR 1.90; P = .005). There was a 13.5% risk of readmission over 2 months while waiting delayed laparoscopic cholecystectomy and a 22.5% risk over the median waiting time (5 months, 9 days). CONCLUSION Emergency laparoscopic cholecystectomy is positively associated with a multitude of operation-related adverse outcomes in acute cholecystitis, compared to delayed laparoscopic cholecystectomy. The benefit of delayed laparoscopic cholecystectomy should be balanced against the significant readmission risk before delayed laparoscopic cholecystectomy. Emergency laparoscopic cholecystectomy may be the most pragmatic strategy for centers dealing with high volumes of biliary admissions and long elective-surgery waiting times. When opting for delayed laparoscopic cholecystectomy, confirming the date of surgery before discharge may ensure timely intervention and avoid the morbidity and expense of readmission.
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Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom.
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, Dundee, United Kingdom
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Akkurt G, Akkurt B, Alptekın E, Birben B, Keşkek M, Erel Ö. Efficacy of Thiol Disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy. Comb Chem High Throughput Screen 2021; 24:433-440. [DOI: 10.2174/1386207323666200709165910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 05/16/2020] [Indexed: 11/22/2022]
Abstract
Aim:
The aim of this study was to investigate the efficacy of thiol disulfide homeostasis
and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be
encountered during laparoscopic cholecystectomy.
Materials and Methods:
The study included 65 patients who underwent laparoscopic
cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training
and Research Hospital. All patients’ demographic data, previous history of cholecystitis, a history
of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT),
amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gall
bladder, duration of hospital stay, duration of operation, thiol disulfide and IMA values were
evaluated.
Results:
Native thiol and total thiol averages were higher in patients without a history of
cholecystitis, and on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate,
native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis.
While there was a statistically significant negative correlation between native and total thiol values
and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol,
Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer
duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total
thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of
intraoperative pericholecystic adhesion increased.
Conclusion:
We believe that the evaluation of thiol disulfide homeostasis and IMA parameters
prior to laparoscopic cholecystectomy can be used as an effective method for predicting
intraoperative difficulties.
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Affiliation(s)
- Gökhan Akkurt
- Ankara City Hospital, General Surgery Universiteler, 1604. Cd. No: 9 D: No: 9, 06800, Ankara, Turkey
| | - Burcu Akkurt
- Mengen State Hospital, Family Medicine Department, Bolu, Turkey
| | - Emel Alptekın
- Ladik State Hospital, Family Medicine Department, Samsun, Turkey
| | - Birkan Birben
- Ankara City Hospital, General Surgery Department, Ankara, Turkey
| | - Mehmet Keşkek
- Ankara City Hospital, General Surgery Department, Ankara, Turkey
| | - Özcan Erel
- Yildirim Beyazit University Faculty of Medicine, Biochemistry Department, Ankara, Turkey
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Bouassida M, Zribi S, Krimi B, Laamiri G, Mroua B, Slama H, Mighri MM, M'saddak Azzouz M, Hamzaoui L, Touinsi H. C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases. J Gastrointest Surg 2020; 24:2766-2772. [PMID: 31768828 DOI: 10.1007/s11605-019-04459-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels. METHODS This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery. RESULTS On multivariable logistic regression analysis, male gender (OR = 0.4; p = 0.05), diabetes mellitus (OR = 7.8; p = 0.005), 3-4 ASA score (OR = 5.34; p = 0.037), body temperature (OR = 2.65; p = 0.014), and CRP (OR = 1.01; p = 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003-1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion. CONCLUSION CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter-international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.
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Affiliation(s)
- Mahdi Bouassida
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. .,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Slim Zribi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Krimi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ghazi Laamiri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Mroua
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Helmi Slama
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed M'saddak Azzouz
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Lamine Hamzaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Zhang ZM, Zhang C, Liu Z, Liu LM, Zhu MW, Zhao Y, Wan BJ, Deng H, Yang HY, Liao JH, Zhu HY, Wen X, Liu LL, Wang M, Ma XT, Zhang MM, Liu JJ, Liu TT, Huang NN, Yuan PY, Gao YJ, Zhao J, Guo XA, Liao F, Li FY, Wang XT, Yuan RJ, Wu F. Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review. World J Clin Cases 2020; 8:4908-4916. [PMID: 33195660 PMCID: PMC7642542 DOI: 10.12998/wjcc.v8.i20.4908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable.
CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation.
CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital’s epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.
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Affiliation(s)
- Zong-Ming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Li-Min Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Ming-Wen Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Bai-Jiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai-Yan Yang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jia-Hong Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hong-Yan Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xue Wen
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Li-Li Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Man Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xiao-Ting Ma
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Miao-Miao Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jiao-Jiao Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Tian-Tian Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Niu-Niu Huang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Pei-Ying Yuan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yu-Jiao Gao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jing Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xi-Ai Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fang Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Feng-Yuan Li
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xue-Ting Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Rui-Jiao Yuan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fang Wu
- Department of Pathology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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Rajab IM, Majerczyk D, Olson ME, Addams JMB, Choe ML, Nelson MS, Potempa LA. C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights. BIOPHYSICS REPORTS 2020. [DOI: 10.1007/s41048-020-00108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Role of procalcitonin as a predictor in difficult laparoscopic cholecystectomy for acute cholecystitis case: A retrospective study based on the TG18 criteria. Sci Rep 2019; 9:10976. [PMID: 31358829 PMCID: PMC6662745 DOI: 10.1038/s41598-019-47501-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Difficult laparoscopic cholecystectomy (DLC) is difficult to precisely predict before operation. This observational cohort study aimed to evaluate the predictive value of procalcitonin (PCT) for DLC in patients with acute cholecystitis (AC). A total of 115 patients were included in the study from January 2017 to April 2018. Multiple logistic regression and receiver-operating characteristic (ROC) were performed to evaluate the predictive value of PCT levels in DLC. Patients with DLC had significantly higher Tokyo Guidelines 2018 (TG18) grade (P = 0.002) and levels of C-reactive protein (CRP) (P = 0.007) and PCT (P < 0.001). The cut-off value of PCT for predicting DLC was 1.50 ng/ml. The sensitivity and specificity were 91.3% (95% CI 78.3–97.1) and 76.8% (95% CI 64.8–85.8), respectively. The area under ROC curve was 92.7% (95% CI 88.2–97.3, P < 0.001). Our results suggested that PCT was a good predictor for DLC in the AC patients, but further research is necessary. Monitoring of PCT trends in AC patients may be useful for preoperative risk assessment.
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