C-reactive protein as a predicting factor for difficult laparoscopic cholecystectomy or its conversion to open cholecystectomy in acute calculous cholecystitis: an observational study.

INTRODUCTION

Acute calculous cholecystitis (ACC) is a common surgical emergency often requiring laparoscopic cholecystectomy (LC), though some cases necessitate conversion to open cholecystectomy (OC). Predicting difficult LC or conversion is crucial for operative planning. This study evaluates the role of C-reactive protein (CRP) as a predictor of surgical complexity in ACC.

METHODS

A prospective observational study was conducted at Shree Birendra Hospital, Kathmandu, from April 2024 to March 2025, including 108 patients undergoing emergency LC for ACC. Patients with conditions confounding CRP levels were excluded. Preoperative CRP levels were measured, and operative time was recorded. LC lasting more than 60 min was defined as difficult. Statistical analysis was performed using SPSS 26.0.

RESULTS

Among 108 patients (mean age 49.8 years, male to female ratio 1:3.5), 71 underwent simple LC, 28 difficult LC, and 9 were converted to OC. Mean CRP levels were 18.2 mg/L in simple, 36 mg/L in difficult, and 50.1 mg/L in converted cases (p = 0.002). A significant association was found between elevated CRP and surgical complexity (p < 0.001). Duration of surgery and hospital stay increased with complexity (p < 0.001), while age and gender showed no significant association.

CONCLUSIONS

Elevated preoperative CRP levels are significantly associated with increased surgical complexity and likelihood of conversion in ACC. CRP can serve as a valuable tool for anticipating technical challenges and optimizing resource, especially in resource limited setting.