Doğukan DURAK, Ertugrul Gazi ALKURT, Mehmet Berksun TUTAN

CRP, WBC and monocyte/lymphocyte ratio relation as a preoperative predictive factor for adhesions observed during laparoscopic cholecystectomy

Introduction: Inflammation can adversely affect an operation. The ımportant markers of this inflammation are CRP (C-reactive peptide), WBC (white blood cell). Aim: The purpose of this study to predict adhesion related technical difficulties during operation by comparing preoperative CRP, WBC, Monocyte/Lymphocyte ratio and intra-operative adhesion findings. Method: This was a retrospective study. This study includes 116 elective and emergency cholelithiasis cases whose operation performed at Corum Erol Olcok Training and Research Hospital in 2020 and 2021. Adhesions on gallbladder were graded during operation and divided into two groups. Groups graded based on intra-operative findings were compared with preoperative CRP, WBC, and monocyte/lymphocyte ratio. Results: The patients were divided into two groups based on the adhesion grade as Grade 1-2 (n=84) and Grade 3-4 (n=32). Average WBC count of Grade 3-4 group was average 11.05 ± 4.45 109 /L and this value was statistically significantly higher (p=0.01) than Grade 1-2 group. Average CRP value of Grade 3-4 group was found as 50.91 ± 77.25 mg/L and this value was significantly elevated (p24.5mg/l), WBC (>11.55 109 /L), monocyte/lymphocyte ratio (>0.2693) cut-off values. Conclusion: Preoperative estimation of adhesion grade helps the surgeon considerably. This study shows that high CRP, WBC, and Mo/Ly ratio values can help the estimation of intensity of adhesions and challenges during operation.

Keywords:

cholecystectomy, intra-operative adhesion C-reactive peptide, white blood cell, monocyte/lymphocyte ratio,

PDF

___

Navez, B, Prevention of bile duct injury (BDI) during cholecystectomy. Acta Chir Belg 2003; 103: 151-3.
Bingener-Casey, J, Richards ML, Strodel WE, Schwesinger WH, Sinirik KR. Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 2002; 6: 800-5.
Tianchong W, Minjun L, Yuehua G, Jiangang B, Yusheng G, Shiyun B. Role of procalcitonin as a predictor in difficult laparoscopic cholecystectomy for acute cholecystitis case: A retrospective study based on the TG18 criteria Observational Study Sci Rep 2019; 9: 10976.
Mahdi B, Slim Z, Bassem K, et al. C-reactive protein is the best biomarker to predict advanced acute cholecystitis and conversion to open surgery. a prospective cohort study of 556 cases. J Gastrointest Surg 2020; 24: 2766-72.
Ercan, M, Bostancı EB, Teke Z, et al. Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic colecystectomy. J Laparoendosc Adv Surg Tech A 2010; 20: 427-34.
Wakabayashi, G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25: 73-86.
Lipman JM, Claridge JA, Haridas M, et al., Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007; 142: 556-63.
Kama NA, Doganay M, Dolapci M, Reis E, Atli, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 2001; 15: 965-8.
Lee NW, Collins J, Britt R, Britt LD. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. Am Surg 2012; 78: 831-3.
Agrawal N, Singh S , Khichy S. Preoperative prediction of difficult laparoscopic cholecystectomy: a scoring method. Niger J Surg 2015; 21: 130-3.
Beliaev A , Booth M. C-reactive protein as a diagnostic and prognostic marker for acute cholecystitis and safety conversion of laparoscopic cholecystectomy, in Advances in Medicine and Biology, Vol 101, L.V. Berhardt, Editor 2016, Nova Science Publishers. p. 15-37.
Wu T, Luo M, Guo Y, Bi J, Guo Y, Bao S. Role of procalcitonin as a predictor in difficult laparoscopic cholecystectomy for acute cholecystitis case: A retrospective study based on the TG18 criteria. Sci Rep 2019; 9: 10976.
Micic D, Stankovic S, Lalic N, Dukic V, Polovina S. Prognostic Value of Preoperative Neutrophil-to-lymphocyte Ratio for Prediction of Severe Cholecystitis. J Med Biochem 2018; 37: 121-7.
Ahmed SE, Rehman S, Edilbe M,Jonker L, Canelo R. Can neutrophil-lymphocyte ratio predict operators’ difficulty in early cholecystectomies; a retrospective cohort study. Ann Emerg Surg 2017; 2: 1016.