Analysis of bailout procedure in laparoscopic cholecystectomy for acute cholecystitis

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>The Tokyo Guidelines 2018 recommend a bailout procedure consisting of fundus-first cholecystectomy, subtotal cholecystectomy, or open conversion to prevent serious complications in cases of difficult laparoscopic cholecystectomy (LC).<jats:bold>Methods: </jats:bold>The hospital records of patients with acute cholecystitis who<jats:bold> </jats:bold>underwent LC from October 2014 to April 2019 were retrospectively analyzed. The clinical data were compared between the standard and bailout groups. A subgroup analysis was performed to compare the fundus-first and subtotal cholecystectomy techniques versus open conversion.<jats:bold>Results: </jats:bold>In total, 160 of 416 Japanese patients who underwent LC were diagnosed with acute cholecystitis. Standard LC was performed in 125 (78%) patients, and a bailout procedure was performed in 35 (22%). The duration from onset to surgery was significantly longer (P = 0.04) and the C-reactive protein (CRP) concentration was significantly higher (P = 0.001) in the bailout than standard group. The surgical outcomes were worse in the bailout group. In the multivariate analysis, a high CRP concentration at diagnosis was an independent predictor of bailout (P = 0.004). In the subgroup analysis, the open group had a significantly longer duration from onset to surgery (P = 0.04) and a significantly higher incidence of preoperative drainage (P = 0.002). With respect to surgical outcomes, the open group had significantly greater blood loss (P = 0.02) and longer hospital stays (P = 0.002). <jats:bold>Conclusion: </jats:bold>A high CRP concentration is a risk factor for a bailout procedure. Early LC should be performed for patients with acute cholecystitis and a high CRP concentration.</jats:p>