Abstract

Dr. Abhijit Sarma and *Dr. Purujit Choudhury

ABSTRACT

Background: Laparoscopic cholecystectomy is considered to be the gold standard for the treatment of gallstones. However, conversion of laparoscopic cholecystectomy to open cholecystectomy is done by surgeons in difficult cases. The aim of the study is to use Hs-CRP level in correlation with ultra-sonographic findings to predict difficult laparoscopic cholecystectomy pre-operatively. It would help in anticipating a difficult laparoscopic cholecystectomy preoperatively, better counselling of patients, avoiding unnecessary laparoscopic dissection and hence less morbidity. Materials and Methods: It is an original study conducted in the department of general surgery of Gauhati Medical College and Hospital. The study group included 40 consecutive patients undergoing laparoscopic cholecystectomy for cholelithiasis. Cholelithiasis was diagnosed on the basis of ultrasonography done preoperatively. Hs-CRP level was determined pre-operatively and postoperatively after 6hrs and 12hrs. It was correlated with ultra-sonographic findings to predict difficult cholecystectomy. Results: The mean value of Hs-CRP was found to be 9.68 mg/L preoperatively, 21.88 mg/L at 6 hours and 26.57 mg/L at 12 hours. While the mean value of Hs-CRP was found to be significantly higher in cases which needed conversion. USG findings such as presence of adhesion, GB wall thickness more than 3mm, and narrow Calot’s triangle, were found to be significant predictors for conversion. On correlation, the positive predictive value increased. Conclusion: Pre-operative values of Hs-CRP when combined with ultrasonography findings, can predict difficult cholecystectomy. It will help in better selection of patients, and help in decreasing morbidity.