Abstract
From January 1992 to December 2000,877 patients of cholecystolithiasis underwent laparoscopic cholecystectomy with preoperative cholangiography in our hospital. Negative cholecystogram which generally points out difficulty of operation was shown in 164 patients (18.7%). The patients with negative cholecystogram were classified into two groups. A: 143 patients whose cholangiography demonstrated cystic duct without compression of common bile duct. B: 21 patients whose cholangiography revealed compression of common bile duct or did not show cystic duct.
Operating time was longer and conversion to an open procedure was higher in the B group (p<0.0001). We consider that the B group have the most difficulty in operation, so we must select an expert surgeon in this group. In the A group, operating time is short in the cases without cholecystitis (62/143) and so we think these cases have little difficulty. Whereas in the cases with cholecystitis (81/143), operating time was longer than without cholecystitis (p<0.0001), we regard these as difficult cases.
In the case with cholecystitis, it has been shown that operating time correlate with the rise period of CRP (mg/dl). So, it is suggest that the rise period of CRP could be one of useful factor for preoperative evaluation of difficulty.
