Laparosc Endosc Surg Sci . 2017; 24(3): 81-84 | DOI: 10.14744/less.2017.73792

Leukocytosis can predict increased risk of conversion in elective laparoscopic cholecystectomy

Uður Ekici¹, Faik Tatli², Murat Kanlioz¹, Tarik Inan^1
1Department of General Surgery, Malatya State Hospital, Malatya, Turkey
²Department of General Surgery, Harran University Faculty of Medicine, Þanlýurfa, Turkey

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard in the treatment of gallbladder diseases. However, open surgery is sometimes inevitable for the procedure to be completed safely. The aim of this study was to evaluate the relationship of some laboratory findings frequently used in the preoperative period to the need to convert to open surgery in LC.
METHODS: The hospital records of 173 patients who underwent LC due to benign gallbladder disease were retrospectively reviewed. Based on preoperative laboratory values, white blood cell count (WBC) >10,000/mm3, alanine aminotransferase >55 IU/L, aspartate aminotransferase >35 IU/L, gamma-glutamyltransferase >65 IU/L, and alkaline phosphatase >150 IU/L were accepted as positive, according to the laboratory kits of the hospital.
RESULTS: Of the 173 patients who were included in the study, 142 (82.0%) were female and 31 (18.0%) were male, and the mean age was 47.3 years (range: 21–81 years). In 159 (91.9%) of the patients, the operation was completed laparoscopically, while in 14 (8.1%) it was converted to open surgery. The most common symptoms seen in the patients were epigastric discomfort and right upper quadrant pain. The preoperative laboratory values of 80 patients were high. Open surgery was preferred in 7 of these patients with high laboratory values. The procedure was converted to open surgery in 5 (25.0%) of the 20 patients with high preoperative WBC value and the level of these preoperative values was found to be statistically significant (p<0.01). A total of 9 conversions to open surgery were required in 153 patients with low WBC score (5.8%).
DISCUSSION AND CONCLUSION: A high WBC value (>10,000/mm3) before elective LC increases the risk of the eventuality of open surgery by 4 times. This finding will help the surgeon to plan the treatment and inform the patient of the possibility before surgery.

Keywords: Cholelithiasis, conversion, laparoscopic cholecystectomy.

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Lökositoz elektif laparoskopik kolesistektomide konversiyon riskini öngörebilir mi?

Uður Ekici¹, Faik Tatli², Murat Kanlioz¹, Tarik Inan^1
1Malatya devlet hastanesi, Genel Cerrahi Bölümü, Malatya
²Harran Üniversitesi Týp Fakültesi Genel Cerrahi Ana Bilim Dalý, Þanlýurfa

GÝRÝÞ ve AMAÇ: Giriþ: Laparoskopik kolesistektomi günümüzde safra kesesi hastalýklarýnýn tedavisinde altýn standarttýr. Ancak açýða geçme bazen operasyonun güvenli sonlandýrýlabilmesi için kaçýnýlmaz olabilmektedir.
Amaç: Ameliyat öncesinde sýklýkla kullandýðýmýz bazý laboratuvar bulgularýnýn Laparoskopik kolesistektomilerde açýða dönüþ ile iliþkisini deðerlendirmeyi amaçladýk

YÖNTEM ve GEREÇLER: Materyal ve Metod: Hastanemizde benign safra kesesi hastalýklarý nedeniyle Laparaskopik kolesistektomi(LK) yapýlan 173 hastanýn kayýtlarý geriye dönük olarak incelendi. Olgular; yaþ, cinsiyet, ameliyat öncesi bulgularý, görüntüleme sonuçlarý, ameliyat öncesi laboratuar deðerleri, ameliyat esnasýnda ve sonrasýnda ki komplikasyonlar, mevcut semptomlarý ve hastalarýn takipleri deðerlendirmeye alýndý. Olgularýn ameliyat öncesi laboratuar deðerlerinden; Beyaz küre sayýsý (WBC) >10,000/ mm3, Alanin amino transferaz (ALT) >55 IU/L, Aspartat amino transferaz (AST) > 35 IU/L, Gama-glutamil transferaz (GGT) >65 IU/L ve Alkalen fosfataz (ALP) >150 IU/Ldeðerleri hastanemiz laboratuar kitlerine göre pozitif olarak kabul edildi.
BULGULAR: Sonuçlar: Çalýþmaya alýnan 173 hastanýn 142 (82.0%)’si kadýn, 31 (18.0%)’i erkekti, ortalama yaþlarý 47,3 (21-81) yýldý. Hastalarýn 159 (91,9%) ’unda ameliyat laparaskopik tamamlanýrken 14 (8.1%)‘nde açýða dönüldü. Laboratuar deðerleri yüksek olan bu hastalardan 7 tanesinde açýða dönüldü. LK yapýlan hastalardan ameliyat öncesi WBC deðeri yüksek olan 20 hastadan 5 (25.0%) ’inde açýða dönüldü ve ameliyat öncesinde bu deðerin yüksekliði istatistiksel olarak anlamlý bulundu (p<0,01). WBC deðeri yüksek olmayan 153 hastada ise toplam 9 açýða dönüþ gerekli oldu (5.8%).
TARTIÞMA ve SONUÇ: Sonuç olarak, elektif laparoskopikkolesistektomi öncesinde WBC deðerinin yüksek olmasý (>10,000/ mm3) açýða dönüþ için riskini 4 kat artýrmaktadýr. Bu durum cerraha tedavinin planlanmasýnda ve ameliyat öncesi hastayý bilgilendirilme sürecinde yardýmcý olacaktýr.

Anahtar Kelimeler: Laparoskopik kolesistektomi, konversiyon, kolelitiyazis

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