{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:59:20Z","timestamp":1785437960316,"version":"3.56.0"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova"},{"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Preoperative risk stratification for laparoscopic cholecystectomy (LC) remains imperfect, particularly in patients with chronic inflammatory remodeling and biliary anatomic variants. Existing tools often focus on acute presentations or intraoperative variables, resulting in uncertainty on how congenital anatomy, recurrent biliary colic, and cystic pediculitis interact. We synthesize a hypothesis-generating conceptual framework and propose an illustrative candidate preoperative rubric for future validation. We performed a structured narrative review of PubMed, Scopus, and Web of Science (January 1990\u2013December 2024; last search: 15 December 2024). Eligible primary studies evaluated clinical history, imaging-defined anatomy, inflammatory biomarkers, and\/or operative outcomes (conversion, intraoperative complications, or operative difficulty) in the setting of LC. Acute cholecystitis and chronic\/elective cohorts were interpreted separately during the narrative synthesis. Two reviewers screened titles\/abstracts and assessed full texts using predefined inclusion\/exclusion criteria; due to heterogeneity, no meta-analysis and no formal risk-of-bias tool were applied. The literature supports a plausible vicious cycle in which biliary anatomic variants may impair drainage and promote stasis, recurrent biliary colic, and chronic inflammation, ultimately leading to fibrosis\/pediculitis and a \u201cfrozen\u201d Calot\u2019s triangle. We translate these signals into an illustrative candidate rubric (0\u201316 points) spanning three domains: clinical history (0\u20136), imaging (0\u20136), and inflammatory biomarkers (0\u20134). Weights and cut-offs (low: 0\u20134; moderate: 5\u20139; high: 10\u201316) were chosen a priori for conceptual clarity and are not data-derived. This review provides a conceptual map and a candidate variable set to support hypothesis generation, standardized data collection, and staged validation. The rubric is not validated and must not be used for clinical decision-making. Planned next steps include feasibility-oriented derivation, followed by prospective multicenter external validation and impact assessment.<\/jats:p>","DOI":"10.3390\/diagnostics16081201","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T11:53:46Z","timestamp":1776426826000},"page":"1201","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Cholecystitis: Anatomical Variants, Pediculitis, and a Candidate Preoperative Framework for Difficult Laparoscopic Cholecystectomy"],"prefix":"10.3390","volume":"16","author":[{"given":"Georgiana-Andreea","family":"Marinescu","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rare\u0219 Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarmis Marian","family":"Sandulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3990-6483","authenticated-orcid":false,"given":"Dumitru","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Taisescu","sequence":"additional","affiliation":[{"name":"Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil-Tiberius","family":"Trasca","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Irina","family":"Caluianu","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorin","family":"Mercut","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 2\u20134 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan","family":"Mercut","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora Daniela","family":"Ciupeanu-Calugaru","sequence":"additional","affiliation":[{"name":"Department of Biology and Environmental Engineering, University of Craiova, 200585 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Stefarta","sequence":"additional","affiliation":[{"name":"Department of Dental Technology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3687-2468","authenticated-orcid":false,"given":"Patricia-Mihaela","family":"Radulescu","sequence":"additional","affiliation":[{"name":"Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Citto","family":"Taisescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200690 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"390","DOI":"10.28982\/josam.978789","article-title":"Laparoscopic cholecystectomy\u2014A safe and feasible procedure in patients with mild-moderate acute cholecystitis: A single-center, prospective, observational study","volume":"6","author":"Ranjan","year":"2022","journal-title":"J. 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