CRP, WBC and monocyte/lymphocyte ratio relation as a preoperative predictive factor for adhesions observed during laparoscopic cholecystectomy

Abstract

Introduction: Inflammation can adversely affect an operation. The ımportant markers of this inflammation are CRP (C-reactive peptide), WBC (white blood cell). Aim: The purpose of this study to predict adhesion related technical difficulties during operation by comparing preoperative CRP, WBC, Monocyte/Lymphocyte ratio and intra-operative adhesion findings. Method: This was a retrospective study. This study includes 116 elective and emergency cholelithiasis cases whose operation performed at Corum Erol Olcok Training and Research Hospital in 2020 and 2021. Adhesions on gallbladder were graded during operation and divided into two groups. Groups graded based on intra-operative findings were compared with preoperative CRP, WBC, and monocyte/lymphocyte ratio. Results: The patients were divided into two groups based on the adhesion grade as Grade 1-2 (n=84) and Grade 3-4 (n=32). Average WBC count of Grade 3-4 group was average 11.05 ± 4.45 109 /L and this value was statistically significantly higher (p=0.01) than Grade 1-2 group. Average CRP value of Grade 3-4 group was found as 50.91 ± 77.25 mg/L and this value was significantly elevated (p<0.001) when compared with Grade 1-2 group. Average monocyte/lymphocyte ratio was found as 0.29±0.18 and 0.52±0.33 for Grade 1-2 and Grade 3-4 groups, respectively and these values were found statistically significant (p<0.001). Adhesions were significantly higher for CRP (>24.5mg/l), WBC (>11.55 109 /L), monocyte/lymphocyte ratio (>0.2693) cut-off values. Conclusion: Preoperative estimation of adhesion grade helps the surgeon considerably. This study shows that high CRP, WBC, and Mo/Ly ratio values can help the estimation of intensity of adhesions and challenges during operation.

Keywords

• cholecystectomy
• intra-operative adhesion
• C-reactive peptide
• white blood cell
• monocyte/lymphocyte ratio

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