Can Gallbladder Wall Thickness and Systemic Inflammatory Index Values Predict the Possibility of Conversion from Laparoscopy to Open Surgery?

Abstract

Background/Objective: This study aims to develop an objective marker that predicts the risk of conversion from laparoscopy to open  surgery using gallbladder wall thickness and inflammatory index values. 

Materials and Methods: A total of 2,920 cholecystectomy  patients were screened, including those whose operations were converted to open and those who underwent laparoscopy. A total of 700 cholecystectomy patients who met the study criteria were included in the study. The same team of surgeons performed all operations.  The conversion probability from laparoscopic to open cholecystectomy was calculated using the ratio obtained by evaluating  inflammatory markers and gallbladder wall thickness (K). The preoperative complete blood count and abdominal ultrasound data of the  patients were obtained from our university patient registry system. 

Results: Age, neutrophil count, gallbladder wall thickness,  neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), KxNLR, and KxPLR values were all significantly higher in the  conversion from laparoscopy to open surgery group compared with the laparoscopic cholecystectomy group. According to the ROC analysis performed on the gallbladder wall thickness values according to the probability of conversion to open surgery, the cutoff value  was determined as >3 mm. Gallbladder wall thickness >KxPLR >KxNLR was defined as the diagnostic value order according to the area  under the curve. 

Conclusions: The results of this study showed that gallbladder wall thickness effectively determines the probability of  conversion from laparoscopy to open cholecystectomy and multiplying the gallbladder wall thickness (mm) by NLR increased the  sensitivity.