The role of histopathologic alterations of gallbladder wall in conversion cholecystectomy
Suleyman Orman1, Ayse Bahar Ceyran2
1Istanbul Medeniyet University Goztepe Training and Research Hospital Department of Gastroenterology Surgery, Istanbul, Turkey
2Istanbul Medeniyet University Goztepe Training and Research Hospital Department of Pathology, Istanbul, Turkey
Aim: We aimed to investigate the role of histopathologic alterations of gallbladder wall in conversion cholecystectomy.
Material and Methods: 3338 laparoscopic cholecystectomies and 121 conversion cholecystectomies that were performed between January 2008 and June 2017 in our hospital were evaluated. Patients were divided into 2 groups as laparoscopic and conversion cholecystectomy groups. Both groups were compared retrospectively by examining the histopathologic data of 140 patients were randomly analyzed.
Results: There was a statistically significant difference between the types of surgery according to necrosis, polymorfonuclear leucocystes, mononuclear cells, edema levels (p <0.01). The incidence of polymorfonuclear leucocystes and mononuclear cells was at the marked and massive levels in cases with conversion cholecystectomy which were higher than in those with laparoscopic cholecystectomy. The rate of severe edema seen in conversion cholecystectomy was higher than in laparoscopic cholecystectomy (p <0.01). There was a statistically significant difference between the types of surgery according to granulation tissue, neoangiogenesis and fibroblast levels (p <0.01). There was a statistically significant difference between the necrosis-edema duple levels and Verhofstadt scores of the cases according to the operation type (p <0.01).
Conclusion: Cholelithiasis histopathology that evaluates intra-mural factors has significant effects on conversion cholecystectomy with extra-mural factors. The increase in Verhofstadt score and Necrosis-Edema duple has been shown to increase the risk of conversion cholecystectomy surgery with great sensitivity. Preoperative superb microvascular imaging and contrast-enhanced ultrasound may helpful in dedecting the necrosis and edema in the gallbladder wall which has also the potential to predict the risk of conversion cholecystectomy.