To evaluate the role of hs-crp levels in combination with ultrasound findings to predict the difficulty in laparoscopic cholecystectomy-a prospective study

Abstract

Background: Detailed preoperative ultrasound evaluation of the gallbladder in patients destined for laparoscopic cholecystectomy is of little value in screening for difficult or unsuitable cases .Therefore other predictors are required to improve the preoperative assessment of the difficulties encountered during laparoscopic surgery and Hs- CRP has been used as one such investigation. Hs-CRP an acute phase reactant is known to increase up to 1000 folds following inflammation and or infection. Methods: A total of 100 patients of cholelithiasis and acute cholecystitis consecutively formed the basis of this study. Results: Gallbladder thickness on ultrasound proved to be a significant predictor of difficult laparoscopic cholecystectomy. The correlation of preoperative CRP with intraoperative finding/grading is highly significant as predictor of difficult cholecystectomy and at times for the reasons of conversion to open surgery. Area under the curve shows that preoperative Hs-CRP of >0.730mg/dl is associated with difficult LC. Diagnostic accuracy of USG combined with pre-op Hs-CRP in predicting difficult laparoscopic cholecystectomy has a sensitivity of 84.1% and specificity of 68.7% . Conclusion: we recommend that preoperative estimation of Hs-CRP should be routinely used as an adjunct with ultrasound as an OPD investigation to evaluate degree of expected operative difficulty and selecting out the high risk patients preoperatively. This will help to plan the surgery by arranging the appropriate team of experienced surgeons and to reduce the morbidity/ mortality associated with it. The health care costs can also be estimated and conveyed to the patient and unnecessary litigations can also be avoided.