Laparosc Endosc Surg Sci . 2022; 29(1): 42-48 | DOI: 10.14744/less.2022.48108

Can the degree of fibrosis in the gallbladder wall be predicted by pre-operative routine examinations in chronic cholecystitis? A retrospective analysis

Ali Kemal Kayapinar¹, Samir Abdullazade^2
1Department of General Surgery, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
²Department of Pathology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey

INTRODUCTION: Fibrosis caused by chronic inflammation in the gallbladder increases the risk of biliary tract injury. Our aim was to investigate a possible correlation between pre-operative routine examinations and the degree of chronic inflammation.
METHODS: Samples from 74 patients with chronic cholecystitis (CC) were reevaluated to determine the degree of chronic inflammation. The relationship of gallbladder wall thickness and gallbladder stone size in pre-operative abdominal ultrasonography (USG), pre-operative laboratory values, and endoscopic retrograde cholangiopancreatography (ERCP) history with the degree of histopathological chronic inflammation in the gallbladder wall was evaluated. In addition, adhesion of the surrounding tissues to the gallbladder, operation time, hospitalization period, biliary tract injury, and post-operative complications were examined in the context of degree of chronic inflammation.
RESULTS: Grade I CC was detected in 53 (69.8%) and Grade II in 21 (27.6%) patients. While the gallbladder wall was thick (>3 mm) on pre operative USG in 7 (33.3%) patients with Grade II CC, it was normal in all patients with Grade I (p<0.001). A history of pre-operative ERCP was found in 2 (3.8%) patients in Grade I CC and in 7 (33.7%) patients in Grade II (p=0.002). In univariate and multivariate analysis, gallbladder wall thickness and history of ERCP were found to be significant in predicting the degree of chronic inflammation [(p<0.001 and p=0.002), (p=0.003 and p=0.014), respectively]. In multivariate analysis, an increase in AST value of 1 U/L increases the probability of CC grade II by 1.1 times compared to CC grade I (p=0.019).
DISCUSSION AND CONCLUSION: Increased gallbladder wall thickness, history of ERCP, and elevated AST value in CC increase the possibility of a high degree of chronic inflammation (fibrosis rate).

Keywords: Chronic cholecystitis, difficult cholecystectomy, endoscopic retrograde cholangiopancreatography, fibrosis, gallbladder wall thickness

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Kronik kolesistitlerde preoperatif rutin tetkikler ile safra kesesi duvarýndaki fibrozis derecesi tahmin edilebilir mi? Retrospektif analiz

Ali Kemal Kayapinar¹, Samir Abdullazade^2
1Saðlýk Bilimleri Üniversitesi Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýzmir
²Saðlýk Bilimleri Üniversitesi Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi, Patoloji Kliniði, Ýzmir

GÝRÝÞ ve AMAÇ: Safra kesesindeki kronik inflamasyonun neden olduðu fibrozis safra yolu yaralanma riskini arttýrmaktadýr. Amacýmýz preoperatif rutin tetkikler ile kronik inflamasyon derecesi arasýnda korelasyon olup olmadýðýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: 74 kronik kolesistitli hastanýn preparatlarý, kronik inflamasyon derecesi belirlemek için tekrar deðerlendirildi. Preoperatif batýn ultrasonografi (USG) deki safra kesesi duvar kalýnlýðýnýn, safra kesesi taþ boyutunun, preoperatif laboratuvar deðerlerinin ve Endoscopic Retrograde Cholangiopancreatography (ERCP) öyküsünün safra kesesi duvarýndaki histopatolojik kronik inflamasyon derecesi ile iliþkisi deðerlendirildi. Ayrýca kronik inflamasyon derecesine göre çevre dokularýn safra kesesine yapýþýklýðý, ameliyat süresi, hastanede yatýþ süresi, safra yolu yaralanmasý ve postoperatif komplikasyonlar incelendi.
BULGULAR: Grade I kronik kolesistit (KS) 53 (%69.8) hastada, grade II KS 21 (%27.6) hastada tespit edildi. Grade II KS olan 7 (%33.3) hastanýn preoperatif USG’de safra kesesi duvarý kalýn (> 3 mm) iken, Grade I KS olan tüm hastalarda duvar kalýnlýðý normaldi (p<0.001). Preoperatif ERCP öyküsü grade I KS’de 2 (%3.8) hastada, grade II KS’de ise 7 (%33.7) hastada vardý (p=0.002). Univaryant ve multivaryant analizde safra kesesi duvar kalýnlýðý ve ERCP öyküsü kronik inflamasyon derecesini öngörmede istatistiksel olarak anlamlý bulunmuþtur [(p<0.001,p=0.002), (p=0.003, p=0.014) sýrasýyla]. Aspartate Aminotransferase (AST) univariant ve multivariant analizde, total bilirubin ise univariate analizde kronik inflamasyon derecesi ile iliþkili bulunmuþtur [(p=0.036, p=0.019), p= 0.014 sýrasýyla].
TARTIÞMA ve SONUÇ: KS’de safra kesesi duvar kalýnlýðýnýn artmasý, ERCP öyküsünün olmasý, AST ve total bilirubin deðerlerinin yükselme eðiliminde olmasý kronik inflamasyon derecesinin (fibrozis oranýnýn) yüksek olma olasýlýðýný arttýrmaktadýr

Anahtar Kelimeler: Kronik kolesistit, zor kolesistektomi, fibrozis, endoscopic retrograde cholangiopancreatography, safra kesesi duvar kalýnlýðý

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