Preoperative C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy: A Cross-Sectional Study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i3.2707Keywords:
C-reactive protein, difficult laparoscopic cholecystectomy, cholelithiasis, acute cholecystitis, inflammatory markersAbstract
Background
Difficult laparoscopic cholecystectomy remains a significant intraoperative challenge and may lead to prolonged operative time, bile duct injury, or conversion to open surgery. Identifying reliable preoperative predictors can help surgeons anticipate technical difficulty and optimize surgical planning. C-reactive protein (CRP), an acute-phase inflammatory marker, may serve as a useful predictor of operative complexity.
Methods
This cross-sectional study was conducted in the Department of General Surgery at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, over a period of one year. Sixty patients diagnosed with cholelithiasis and scheduled for laparoscopic cholecystectomy were included. Preoperative serum CRP levels were measured and correlated with intraoperative findings. Laparoscopic cholecystectomies were classified as easy or difficult based on operative duration (>60 minutes), bile/stone spillage, duct or arterial injury, need for extension of incision, or conversion to open surgery. Statistical analysis was performed to assess the association between CRP levels and operative difficulty.
Results
Sixty patients were included, with a mean age of 42.6±11.8 years; females constituted 63.3% (n=38) and males 36.7% (n=22). Difficult laparoscopic cholecystectomy occurred in 22 (36.7%) patients. Mean preoperative CRP levels were significantly higher among difficult cases than easy cases (24.8±10.6 mg/L vs 6.4±3.2 mg/L, p<0.001). A CRP cutoff value of 15 mg/L predicted difficult laparoscopic cholecystectomy with a sensitivity of 81.8%, specificity of 84.2%, positive predictive value of 75.0%, negative predictive value of 88.0%, and area under the ROC curve of 0.87.
Conclusion
Preoperative serum CRP is a significant predictor of difficult laparoscopic cholecystectomy. Elevated CRP levels may help surgeons anticipate intraoperative challenges and prepare for potential complications, thereby improving operative planning and patient outcomes.
Recommendation
Preoperative serum CRP estimation should be incorporated into the routine assessment of patients undergoing laparoscopic cholecystectomy to facilitate risk stratification and improve operative planning.
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