Preoperative Total Leukocyte Count: A Key Predictor for Better Optimization and Conversion Risk in Laparoscopic Cholecystectomy for Cholelithiasis: Preoperative Total Leukocyte Count: Laparoscopic Cholecystectomy for Cholelithiasis

Hafiz Waqas Ahmed; Rabia Khanum; Tooba Mahmud Gauhar; Safiullah Khan; Rubab Nafees; Jahanzaib Babar

doi:10.54393/pjhs.v6i5.2969

Authors

Hafiz Waqas Ahmed Department of General Surgery, Al-Tibri Medical College, Karachi, Pakistan
Rabia Khanum Department of General Surgery, Al-Tibri Medical College, Karachi, Pakistan
Tooba Mahmud Gauhar Department of General Surgery, Al-Tibri Medical College, Karachi, Pakistan
Safiullah Khan Department of General Surgery, Al-Tibri Medical College, Karachi, Pakistan
Rubab Nafees Department of General Surgery, Fazia Ruth Pfau Medical College, Karachi, Pakistan
Jahanzaib Babar Department of General Surgery, Dow Medical College, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i5.2969

Keywords:

Gallstone Disease, Laparoscopic Cholecystectomy, Total Leucocyte Count, Open Cholecystectomy

Abstract

Gallstone disease requires laparoscopic cholecystectomy (LC) as the standard of care. Sometimes, the surgeon decides to convert LC to open cholecystectomy (OC) for patient safety. Several factors help us predict preoperatively whether there is any chance of conversion of LC to OC. The role of elevated total leucocyte count (TLC) as a predictor for conversion is being proposed. This study investigates the association between pre-operative TLC levels and conversion rates from LC to OC. Objective: To determine the association between increased TLC and conversion from LC to OC. Methods: This study was conducted at Al-Tibri Medical College Hospital, Karachi, over eighteen months from 1st July 2023 to 31st December 2024. A total of 230 patients were included. We selected 115 patients with TLC above 11.0x10^9/L and 115 patients with non-elevated TLC. All patients underwent LC, and conversions to OC were recorded. Data were analyzed using SPSS version 23.0. Mean and standard deviation were computed for numerical variables, and percentages for categorical variables. The chi-square test was applied to find the association between categorical variables. The relative risk (RR) was calculated to compare the risk of conversion of LC to OC among Elevated and Non-elevated TLC Groups. Results: The average age of patients was 31.82±10.06 years. The conversion risk was 117% higher in the elevated TLC group compared to the non-elevated TLC group (RR=2.17, 95%CI: 1.32-3.56). Conclusions: It was concluded that elevated pre-operative TLC is significantly associated with a higher risk of conversion from LC to OC, indicating its potential as a predictive factor for surgical planning.

References

Unalp-Arida A and Ruhl CE. Burden of Gallstone Disease in the United States Population: Pre-pandemic Rates and Trends. World Journal of Gastrointestinal Surgery. 2024 Apr; 16(4): 1130. doi: 10.4240/wjgs.v16.i4.1130. DOI: https://doi.org/10.4240/wjgs.v16.i4.1130

Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F. Gallstones Top to Toe: What the Radiologist Needs to Know. Insights into Imaging. 2020 Dec; 11: 1-4. doi: 10.1186/s13244-019-0825-4. DOI: https://doi.org/10.1186/s13244-019-0825-4

Magnano San Lio R, Barchitta M, Maugeri A, Quartarone S, Basile G, Agodi A. Preoperative Risk Factors for Conversion from Laparoscopic to Open Cholecystectomy: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022 Dec; 20(1): 408. doi: 10.3390/ijerph20010408. DOI: https://doi.org/10.3390/ijerph20010408

Ali G, Zeb M, Khattak A, Khan R, Dawar MK, Zaman K et al. Frequency and Predictors of Conversion from Laparoscopic to Open Cholecystectomy: A Single-Center Observational Study. Cureus. 2024 Dec; 16(12). doi: 10.7759/cureus.76327. DOI: https://doi.org/10.7759/cureus.76327

Amir D and Amin N. Frequency of Complications Due to Laparoscopic Cholecystectomy in Hamedan Hospitals. The Journal of the Pakistan Medical Association. 2012 Jan; 62(1): 13-5.

Yi F, Jin WS, Xiang DB, Sun GY, Huaguo D. Complications of Laparoscopic Cholecystectomy and Its Prevention: A Review and Experience of 400 Cases. Hepato-Gastroenterology. 2012 Jan; 59(113): 47-50.

Bansal A, Mahobia HS, Waghoikar G. A Clinical Study to Determine Predictive Factors for Difficult Laparoscopic Cholecystectomy. International Journal of Surgery. 2020 Oct; 4(4): 126-32. doi: 10.33545/surgery.2020.v4.i4c.547. DOI: https://doi.org/10.33545/surgery.2020.v4.i4c.547

Khan R, Javed U, ur Rehman A. Per-Operative Predictors of Conversion of Laparoscopic Cholecystectomy into Open Procedure: Conversion of Laparoscopic Cholecystectomy. Pakistan Journal of Health Sciences. 2023 Nov: 165-9. doi: 10.54393/pjhs.v4i11.1151. DOI: https://doi.org/10.54393/pjhs.v4i11.1151

Moosa H, Kumar D, Naeem M, Rivzi SB, Bhatti IA, Jaffer S, Qureshi S. Risk Factors Associated with Conversion of Laparoscopic to Open Cholecystectomy. National Journal of Health Sciences. 2023; 8: 13-17. doi: 10.21089/njhs.81.0013. DOI: https://doi.org/10.21089/njhs.81.0013

Amin A, Haider MI, Aamir IS, Khan MS, Choudry UK, Amir M et al. Preoperative and Operative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in Pakistan. Cureus. 2019 Aug; 11(8). doi: 10.7759/cureus.5446. DOI: https://doi.org/10.7759/cureus.5446

Molasy B, Frydrych M, Kubala-Kukus A, Nieroda K, Gluszek S, Gluszek Sr S. Assessment of Risk Factors for Conversion in Laparoscopic Cholecystectomy Performed Due to Symptomatic Cholecystolithiasis. Cureus. 2025 May; 17(5). doi: 10.7759/cureus.84326. DOI: https://doi.org/10.7759/cureus.84326

Dinçer B, Ömeroğlu S, Tufan AE, Uzun MA. Evaluation of Risk Factors Leading to Conversion from Laparoscopic Cholecystectomy to Open Surgery: A Retrospective Controlled Study. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2025 Mar; 35(3): 204-9. doi: 10.1089/lap.2024.0366. DOI: https://doi.org/10.1089/lap.2024.0366

Rafiq N, Khan A, Shabbir I, Ali A. Assessment of the Risk Factors Contributing to Increase Cholelithiasis Cases in Punjab: A Cross Sectional Study. The Research of Medical Science Review. 2024 Dec; 2(3): 1264-70.

Oymaci E, Ucar AD, Aydogan S, Sari E, Erkan N, Yildirim M. Evaluation of Affecting Factors for Conversion to Open Cholecystectomy in Acute Cholecystitis. Gastroenterology Review/Przegląd Gastroenterologiczny. 2014 Jan; 9(6): 336-41. doi: 10.5114/pg.2014.45491. DOI: https://doi.org/10.5114/pg.2014.45491

Mirdamadi A, Javid M, Amini-Salehi E, Mohammadyari F, Tavakoli S, Javid M et al. Preoperative Risk Factors for Laparoscopic to Open Appendectomy Conversion; A Systematic Review and Meta-Analysis. International Journal of Surgery. 2025: 10-97. doi: 10.1097/JS9.0000000000002485. DOI: https://doi.org/10.1097/JS9.0000000000002485

Chin X, Arachchige SM, Orbell-Smith J, Wysocki AP, Orbell-Smith JL. Preoperative and Intraoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Systematic Review of 30 Studies. Cureus. 2023 Oct; 15(10). doi: 10.7759/cureus.47774. DOI: https://doi.org/10.7759/cureus.47774

Bazoua G and Tilston MP. Male Gender Impact on the Outcome of Laparoscopic Cholecystectomy. Journal of the Society of Laparoendoscopic Surgeons. 2014 Jan; 18(1): 50. doi: 10.4293/108680813X13693422518830. DOI: https://doi.org/10.4293/108680813X13693422518830

Bhandari TR, Shahi S, Bhandari R, Poudel R. Laparoscopic Cholecystectomy in the Elderly: An Experience at A Tertiary Care Hospital in Western Nepal. Surgery Research and Practice. 2017; 2017(1): 8204578. doi: 10.1155/2017/8204578. DOI: https://doi.org/10.1155/2017/8204578

Iftikhar N, Naeem M, Ansari SS, Shaikh AR. Frequency of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in a Low-Middle-Income Country. J Community Med Public Health. 2023; 7(356): 2577-228. doi: 10.29011/2577-2228.100356. DOI: https://doi.org/10.29011/2577-2228.100356

Thyagarajan M, Singh B, Thangasamy A, Rajasekar S. Risk Factors Influencing Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy. International Journal of Surgery. 2017 Sep; 4(10): 3354-7. doi: 10.18203/2349-2902.isj20174495. DOI: https://doi.org/10.18203/2349-2902.isj20174495

Bhattacharjee SS, Arun BR, Suresh G, Chakrabartty DK. A study on Pre-Operative Risk Factors (USG Score) in Predicting the Conversion from Laparoscopic Cholecystectomy to Open Surgery in A Tertiary Care Hospital in India. Journal of the West Bengal University of Health Sciences. 2020; 1(2): 19-25.