{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:55:19Z","timestamp":1793393719077,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p &lt; 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p &lt; 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision.<\/jats:p>","DOI":"10.3390\/diagnostics14030346","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T09:31:58Z","timestamp":1707125518000},"page":"346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Paul Lorin","family":"Stoica","sequence":"first","affiliation":[{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1380-2112","authenticated-orcid":false,"given":"Dragos","family":"Serban","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8612-6293","authenticated-orcid":false,"given":"Dan Georgian","family":"Bratu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania"},{"name":"Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crenguta Sorina","family":"Serboiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Ovidiu","family":"Costea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania"},{"name":"General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Carina","family":"Tribus","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalin","family":"Alius","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8413-0977","authenticated-orcid":false,"given":"Dan","family":"Dumitrescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7474-2395","authenticated-orcid":false,"given":"Ana Maria","family":"Dascalu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corneliu","family":"Tudor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurentiu","family":"Simion","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Department of Surgical Oncology, Institute of Oncology \u201cProf. Dr. Al. Trestioreanu\u201d, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihail Silviu","family":"Tudosie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meda","family":"Comandasu","sequence":"additional","affiliation":[{"name":"Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Cosmin","family":"Popa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"},{"name":"Department of General Surgery, Colentina Clinic Hospital, 020125 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Mihai","family":"Cristea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/SLA.0000000000003791","article-title":"Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy","volume":"272","author":"Brunt","year":"2020","journal-title":"Ann. 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