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. 2016 Jan-Mar;12(1):26-32.
doi: 10.4103/0972-9941.158963.

Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study

Kam Wa Jessica Mok  1 , Yan Li Goh  1 , Laura E Howell  2 , Ravindra S Date  1
Affiliations

Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study

Kam Wa Jessica Mok et al. J Minim Access Surg. 2016 Jan-Mar.

Abstract

Introduction: Both converted and difficult laparoscopic cholecystectomies (LC) have impact on operating time and training of juniors. The aim of this study is to evaluate parameters that predict difficult LC or conversion (C), and find predictive values for different cut-off points of C-reactive protein (CRP) for conversion.

Materials and methods: A retrospective cohort study of cholecystectomies performed from January 2011 to December 2012 at NHS trust was undertaken. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP, white blood cell count (WBC), history of pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP).

Results: Two hundred and ninety one patients were analysed (222 laparoscopic, 45 difficult LC and 24 C). Only 141 patients had a recorded CRP. Median CRP was highest for patients who were converted (286.20) compared to those who had difficult LC (67.40) or LC (7.05). Those patients who did not have preoperative CRP (8/150, 5.3%) had less chance of conversion than those who had CRP (16/141, 11.34%) (P = 0.063). Patients with CRP of ≤220 (3/91, 3.2%) had significantly less chance of conversion than those with CRP >220 (13/21, 61.9%) (P < 0.001). High preoperative CRP, WBC count and ERCP, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion.

Conclusion: CRP can be a strong predictor of conversion of LC. Further validation of the results is needed.

Keywords: C-reactive protein; difficult dissection; laparoscopic cholecystectomy; predicting conversion.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flowchart showing patient distribution in three groups
Figure 2
Figure 2
Box plot of C-reactive protein by type of operation (n = 141, laparoscopic = 96, difficult dissection = 29 and conversion = 16)
Figure 3
Figure 3
Receiver operating characteristic curve for C-reactive protein (n = 112)
Figure 4
Figure 4
Receiver operating characteristic curve for model produced in Table 5
See this image and copyright information in PMC

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