Assessment Of Blood C-Reactive Protein Levels As A Predictor Of Difficult Laparoscopic Cholecystectomy - A Hospital Based Cross-Sectional Study

Abstract

INTRODUCTION: Laparoscopic cholecystectomy is the treatment of choice for symptomatic gall stone disease and for selected cases of acute cholecystitis. Difficult laparoscopic cholecystectomy and conversion to open surgery are known to increase post-operative morbidity. Thus, it is essential to have a simple pre-operative indicator to predict the same. OBJECTIVE: To find out if blood CRP levels can predict intra-operative factors that can objectively be used to assess difficulty in laparoscopic cholecystectomy and to evaluate C reactive protein as a predictor for conversion to open surgery. MATERIALS AND METHODS: This one-year cross-sectional study was done with the Department of Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2017 to December 2017. A total of 100 patients posted for laparoscopic cholecystectomy were studied. Pre-operative hs-CRP (High sensitivity C-reactive protein) levels were analysed with conversion to open procedure and intra-operative difficulty based on findings including adhesions, empyema, wall thickening, difficulty in grasping and perforation. RESULTS: Yoden index was calculated using different levels of hs-CRP as cut-off. It was found to be optimum (77.98) at 4mg/L. It was found that patients with hs-CRP>4mg/L had a higher incidence of intra-operative difficulty that was statistically significant (P<0.001) with a sensitivity of 88.89% and a specificity of 89.09%. Conversion to open surgery had a higher incidence in patients having hs-CRP higher than 10mg/L (P=0.005). CONCLUSION: Based on these results, C-reactive protein (by measurement of hs-CRP) can be used as an effective independent predictor of difficult laparoscopic cholecystectomy above 4mg/L and conversion to open procedure above 10mg/L.