Predictors of the Difficulty of Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage for Grade II Acute Cholecystitis.

Abstract

The predictors of difficulty performing laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for grade II acute cholecystitis have not been clearly understood. This retrospective study was performed between January 2019 and February 2023 and involved 102 eligible patients with grade II acute cholecystitis. Patients were categorized into 2 groups: difficult LC group (n=14) and nondifficult LC group (n=88). Preoperative characteristics and postoperative outcomes were analyzed, and a logistic regression model was used for multivariate analyses of the significant factors identified in the univariate analyses. Logistic multivariable regression analysis revealed that C-reactive protein (CRP) levels (odds ratio [OR]: 1.028, 95% confidence interval [CI]: 1.013-1.044; P<0.05), and time intervals between PTGBD and LC (OR: 1.047, 95% CI: 1.003-1.092; P=0.034) were independent predictors of difficult LC. When preoperative CRP was >154mg/L, LC difficulty, blood loss, and operative time increased (P<0.05, P=0.01, P=0.01, respectively) compared with CRP <154mg/L. Difficult LC, increased blood loss, and longer operative time occurred more frequently when the interval between PTGBD and LC was >35 days compared with <35 days (P<0.05, P=0.003, P=0.002, respectively). CRP levels >154mg/L and intervals between PTGBD and LC exceeding 35 days are associated with greater LC difficulty.