Assessment of the risk for cholecystitis when performing laparoscopic cholecystectomy in a retrospective cohort study

Abstract

Background/Aim: Acute cholecystitis most often occurs as an acute exacerbation of chronic cholecystitis. In over 90% of patients, the primary factor in the development of acute cholecystitis is the obstruction of the gallbladder or cystic duct with an impacted calculus. In less than 10% of patients, acute cholecystitis can be attributed to other causes: direct trauma to the biliary tract, torsion of the gallbladder, twisting of the vascular loop after surgical procedures on the abdominal organs, and Salmonella typhi infection. The aim of this study is to compare preoperative variables in patients with acute cholecystitis, which are not only important for diagnosis but also have significance in determining the severity of acute cholecystitis in the preoperative period. Methods: This retrospective systematic research included all clinical cases diagnosed with acute cholecystitis from January 2019 to December 2019, totaling 56 patients at CHC Kosovska Mitrovica. For the study, data from medical records were used for statistical analysis. Results: A total of 56 patients (mean age 53 years; 26 men and 30 women) were included in this study. Among them, 32 patients (57.15%) had characteristics of simple cholecystitis, while 24 patients (42.85%) had severe cholecystitis. The group with severe cholecystitis consisted of older patients, with equal representation of both sexes, and higher levels of WBC, NE%, PLT, ALT, GGT, total bilirubin, and CRP (P<0.05). Imaging studies showed that the group with severe cholecystitis exhibited significantly more wall distension, particularly in the stratified wall, compared to the group with simple cholecystitis (P<0.05). Severe cholecystitis was associated with statin use (79.2%) and triglyceride values of 1.55 (0.47); both variables showed a statistically significant association with severe cholecystitis (P<0.05). Conclusion: It is extremely important to skillfully identify patients with simple or severe forms of acute cholecystitis. Possible solutions include organizing campaigns to raise public awareness for faster consultations in cases of acute abdominal pain, establishing universal health coverage (diet), and improving technical platforms.