A PREDICTIVE OUTCOME ANALYSIS OF INTERVAL CHOLECYSTECTOMY BASED ON GALL BLADDER INFLAMMATION STATUS DURING IMMEDIATE LAPAROSCOPIC CHOLECYSTECTOMY

Objective. For unsafe (seriously ill or debilitated)  and severe cholecystitis patients,  percutaneous cholecystostomy  with scheduled  interval cholecystectomy  (IC)  has been advocated;  however, because of lacking an inflammation grading system none of the published data comparing changes of inflammation status is available. Background. Using a self-designed gallbladder (GB) inflammation grading system, the author tried to predict outcomes of IC and reappraise whether delayed IC is justified. Methods. The intraoperative  inflammation of 260 consecutive laparoscopic cholecystectomy  (LC) patients with symptomatic  GB stone diseases was graded (I–VI). Based on grading criteria, predicted outcomes were categorized as “improve”, “unpredictable”, “no change”,  and “worsen”. Results. Predictive results of these four categories for Grades I–III  (inflammation limited to GB) were 23.7, 2.5, 73.0, and  1.4%;  14.3,  57.1,  14.3,  and  14.3%;  7.7,  53.8,  7.7,  and  30.8% respectively.  For  Grade  IV (mild  to  moderate inflammation of Calot’s triangle) they were 11.5, 9.6, 30.8, and 50.0%. For Grades V (severe inflammation of Calot’s triangle) and VI (severe inflammation involving the hepatoduodenal ligament) they were 0, 0, 0, and 100%. All 3 common bile duct injuries were in the “worsen” category. Conclusion. Our findings do not favor IC. For simple GB (Grades  I–IV), immediate  LC can be done safely and IC is unnecessary.  For  difficult  GB  (Grade   V–VI),   IC  brings  no  improvement.  Interval  waiting  to  downgrade  the inflammation seems impractical,  especially for difficult  GB.  Our  inflammation grading  system can  provide  actual inflammation data during cholecystostomy and IC for judging the justification of the delayed IC policy.