Mini-Review
Volume 5 Issue 1
Igor Cerni*
December 13, 2024
DOI : 10.56831/PSSRP-05-157
Abstract
Aims: The article describes the impact of various prognostic elements (CRP, age, duration of symptoms, operator skills, US examination) on the selection of operative method for patients with acute cholecystitis, and consequently displays the suggested preoperative scoring system.
Methods: The retrospective survey included patients operated for acute gallbladder inflammation during the period 2019-2023. Patients were divided into three groups: age (below 30, from 30-60, and above 60), CRP value (CRP<50mg/l, 50-100mg/l, CRP>100mg/l), duration of symptoms (below 3 days, 4-7 days, over 7 days), US examination (wall thickness 2mm, 4mm, more than 4mm), operator skill level (less than 50 operations a year, from 50-70 annually, over 70 annual operations). Each prognostic element was relevantly assessed, and resulted in the elaboration of preoperative scoring system for the laparoscopic cholecystectomy (LCH).
Results: During the indicated three years period 339 patients were operated; of those, 46.6% underwent the laparoscopic method, while 14.2 % needed conversion. Average CRP value in patients with LCH was 84.6mg/l, while the traditional open method indicated 125.5mg/l. Average duration of symptoms in LCH amounted to 2.7 days, and in traditional open method 4.1 days. Mean age of patients treated with laparoscopic method was younger (58.3 years), while the US examination both in LCH and the traditional open method indicated average wall thickness of 2-4 mm. Most LCH operations were performed by operators with over 70 performed annual operations. Screened patients over 60 years of age, CRP values exceeding 100mg/l, and duration of symptoms in excess of 7 days indicated significantly increased number of conversions, resulting in decisions for immediate open method cholecystectomy. Experience level of the operator significantly affected the percentage of conversions and consequent decisions for immediate open cholecystectomy (p<0.01). Each element was statistically evaluated and scored from 1-3, and the results were used in devising a scheme for preoperative classification of patients – preoperative scoring system (PSS).
Conclusion: Preoperative scoring system represents valuable reference for the operator in selecting the method of operation for patients with acute cholecystitis. Whilst any patient exceeding the PSS 11 is not suitable for LCH since there is almost 100% probability of conversion, the patients with PSS ranging from 5-9 are likely material for the LCH.
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