DEVELOPMENT AND VALIDATION OF A PREDICTIVE MODEL FOR INTRAOPERATIVE COMPLICATIONS DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE OBSTRUCTIVE CALCULOUS CHOLECYSTITIS
DOI:
https://doi.org/10.11603/2414-4533.2025.2.15389Keywords:
acute obstructive calculous cholecystitis, laparoscopic cholecystectomy, intraoperative complications, predictive model, sonographic criteriaAbstract
The aim of the work: to develop and validate a comprehensive predictive model for intraoperative complications during laparoscopic cholecystectomy (LC) for acute obstructive calculous cholecystitis, based on objective sonographic and intraoperative criteria.
Materials and Methods. A retrospective analysis was conducted on 408 patients diagnosed with acute cholecystitis. Patients were stratified into three groups according to the duration of symptoms from the onset of the first biliary colic episode: ≤3 days, 3–5 days, and 6–10 days. The staging of acute cholecystitis was assessed based on the duration of cystic duct obstruction and the presence of comorbid conditions. Optimal timing for laparoscopic cholecystectomy was proposed and corroborated by histopathological examination of resected gallbladders, along with correlation analyses of acute cholecystitis risk factors. These results emphasize the importance of careful preoperative evaluation and a differentiated approach to surgical treatment of different forms of cholecystitis, taking into account the identified risk factors.
Results. Univariate and multivariate analyses were performed to identify factors associated with complex laparoscopic cholecystectomy. Odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. Statistical analysis was conducted using SAS software (SAS Institute, Cary, NC, USA). Preoperative evaluation of sonographic markers enabled risk stratification and informed preventive strategies for anticipated intraoperative complications, including consideration of alternative therapeutic approaches. The actual incidence of intraoperative complications was lower than predicted across all complication types (8.6 % observed vs. 11.0 % predicted; OR=0.76; 95 % CI: 0.48–1.20). The identified predictive factors demonstrated utility in estimating the likelihood of intraoperative complications.
Conclusions. The proposed predictive model, based on objective sonographic and intraoperative criteria, facilitates optimization of surgical management in patients with acute obstructive calculous cholecystitis. It enables risk assessment, improves intraoperative decision-making, and supports strategies for the prevention of potential complications.
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