Can Hemogram Parameters and Derived Ratios Predict Conversion From Laparoscopic to Open Cholecystectomy?

Abstract

Backgrounds Laparoscopic cholecystectomy (LC) is the gold standard for surgical removal of gallbladder today. In challenging cholecystectomy cases, conversion to an open technique may be necessary. Therefore, the preoperative prediction of conversion to open technique holds significant importance for patient safety and surgical strategy. In the literature, conversion to open cholecystectomy has been associated with many contradictory predictive factors. The aim of this study is to identify and comprehensively evaluate the predictive laboratory parameters and ratios associated with the conversion from laparoscopic to open cholecystectomy. Methods In this historical cohort study, the data of patients who were scheduled for and underwent LC between January 1, 2018, and September 1, 2023, were retrospectively evaluated. The preoperative laboratory findings and surgical notes of the patients were reviewed retrospectively from the archives. The correlation between patient data and the cholecystectomy groups was analyzed, and comparisons were made between the groups. Results All 160 patients initially underwent a laparoscopic approach. In emergency cases, a statistically significant association was found between lymphocyte count (p = 0.017) and lymphocyte-to-monocyte ratio (LMR) (p = 0.041) with operations completed laparoscopicallyand between neutrophil-to-lymphocyte ratio (NLR) (p = 0.007) and Systemic Inflammatory Response Index (SIRI) (p = 0.031) with operations converted to open surgery. In elective cases, gamma-glutamyl transferase (GGT) (p = 0.024) and total bilirubin (TBIL) (p = 0.003) were found to have a statistically significant association with operations converted to open surgery. In the logistic regression analysis, hematological parameters and ratios were not found to have a statistically significant relationship in predicting the conversion to open surgery. Conclusion Although significant differences were observed in laboratory parameters and derived ratios such as the NLR and LMR, logistic regression analysis did not identify any of these measures as significant predictors of conversion from laparoscopic to open surgery. Further prospective studies with larger sample sizes are needed in this area.