Is there a relationship between surgical technique and postoperative complication rates in xanthogranulomatous cholecystitis? A retrospective single center study

Is there a relationship between surgical technique and postoperative complication rates in xanthogranulomatous cholecystitis? 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A retrospective single center study Semra Demirli Atici, Ufuk Uylas, Erdinc Kamer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5717540/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to compare the relationship between type of surgery and preoperative findings and postoperative (early and late) complications in patients with xanthogranulomatous cholecystitis (XCG). Methods This retrospective study analyzed 127 patients with histopathologically diagnosed XGC after evaluating 9248 cholecystectomy specimens between 2010 and 2020. Patients were divided into two groups according to surgery type: laparoscopic cholecystectomy (LC) and laparoscopy converted to open cholecystectomy (LCOC). Patient demographic characteristics, preoperative laboratory parameters, operation time, and early and late postoperative complications were recorded. Results The study included 94 patients aged 26–76 years, of whom 48 (51.06%) were female and 46 (48.94%) were male. The female-to-male ratio is 0.982. No differences were found in LC and LCOC in terms of age, sex, preoperative white blood cell count, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio (p > 0.05). Surgery time, length of hospital stay, and postoperative early complication rate were lower in the LC group (p 0.05). Conclusion Preoperative inflammatory parameters for XGC are insufficient to predict the type of surgery. LC was associated with a decreased rate of early postoperative complications, whereas no difference was observed between surgery type and late postoperative complication rates. General Surgery Surgery Xanthogranulomatous cholecystitis subtotal cholecystectomy gallbladder cancer acute cholecystitis laparoscopic cholecystectomy Introduction Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease that can be focally or widely seen in the gallbladder and is difficult to diagnose and treat [1]. This condition, a rare variant of chronic cholecystitis, is often benign [2]. The definitive treatment is surgery; it has been reported that the rate of open cholecystectomy or laparoscopy converted to open cholecystectomy (LCOC) is high [3]. The type of surgical procedure performed for XGC, which is difficult to diagnose preoperatively (extensive resection or subtotal cholecystectomy), may lead to increased surgical morbidity and prolonged hospital stay [2]. The use of laboratory parameters, such as the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), in predicting inflammatory processes has become increasingly common in recent years. These parameters have been associated with processes such as morbidity, mortality, prolonged operation time, and hospital stay in many diseases [4]. The primary aim of our study was to determine the relationship between the type of surgery performed in patients diagnosed with XGC and the rates of early and late postoperative complications. The secondary aim was to determine the relationship between preoperative laboratory and inflammatory parameters of the patient and the type of surgery performed in patients diagnosed with XGC. Material and Methods The data of patients who underwent elective surgery for cholelithiasis at the Department of General Surgery of the University of Health Sciences Tepecik Training and Research Hospital between 2010 and 2020 were retrospectively scanned using the hospital automation system. A total of 9248 patients who underwent surgery were analyzed. Patients aged < 18 years, those who underwent emergency surgery for acute cholecystitis, open surgery, open or laparoscopic subtotal cholecystectomy, different surgical interventions performed together with cholecystectomy (choledochal exploration, hepatectomy, hernia repair, or colectomy), pregnant patients, and those with incomplete medical records were excluded from the study. Patients aged > 18 years who underwent elective surgery for cholelithiasis, confirmed by preoperative radiological imaging (abdominal ultrasonography, abdominal computed tomography, or magnetic resonance imaging), laparoscopic cholecystectomy (LC), or did not undergo different surgical interventions (choledochal exploration, hepatectomy, hernia repair, or colectomy) together with cholecystectomy, and were converted to open laparoscopic techniques were included in the study. Operations performed by surgeons who performed more than 40 LC per year were included in the study because it is recommended that a surgeon should perform a minimum of 200 LC over 5 years (i.e., 40 cases per year) to minimize morbidity and improve outcomes [5]. Patients with a histopathologically confirmed diagnosis of XGC, who met the inclusion criteria, were analyzed. The patients were divided into two groups based on the type of surgery: LC and LCOC. The demographic characteristics of the patients (age and sex), preoperative laboratory parameters, type of operation, operation time, length of hospital stay, readmission within 30 days of surgery, and postoperative early ( 30 days up to 6 months) morbidity and mortality were recorded. This retrospective study was approved by the Clinical Research Ethics Committee of the University of Health Sciences, Tepecik Training and Research Hospital (Decision Number: 2021/05–08). This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Statistical Analysis Statistical analyses were performed using the IBM SPSS Statistics software, SPSS v26.0. For descriptive statistics, the number of individuals (n), percentage (%), mean ± standard deviation (SD), and median (Q1–Q3) were calculated. Pearson’s Chi-square tests were used to evaluate categorical variables. The results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). In the comparisons of continuous variables between the two groups, the Independent Samples T-test was used for variables with normal distribution, and the Mann– Whitney U test was used for variables that did not fit a normal distribution. Univariate analysis was performed to identify potential risk factors, and multivariate analysis was performed to identify independent factors. Statistical significance was set at p < 0.05. Results XGC was detected in 127 (%1.37) of the 9248 cholecystectomy specimens. The patients who met the inclusion criteria included 48 female and 46 male (n = 94) and were retrospectively analyzed. The mean age of the patients was 54.6 ± 14.043 years. The female-to-male ratio is 0.982. There were 27 females (47.4%) and 30 males (52.6%) in the LC group and 21 females (56.8%) and 16 males (43.2%) in the LCOC group, respectively. There was no statistically significant difference in the sex distribution between the groups (p = 0.374). The demographic characteristics of the patients are summarized in Table 1. All patients underwent radiological examination before surgery to confirm the presence of gallstones or sludge. All patients (n = 94) who met the inclusion criteria were started laparoscopically. 57 (60.7%) patients underwent laparoscopic surgery and 37 (39.3%) underwent open surgery. The median operation time was 90 min (30–200 min) for LC and 125 min (75–255 min) for LCOC. The operation time for LC was shorter than that for LCOC (p < 0.001) (Table 1). When the preoperative laboratory parameters and values ​​indicating inflammatory processes were compared between groups, no significant differences were observed. The parameters are listed in Table 2. Postoperative complications were evaluated under two subheadings: early and late. Early postoperative (< 30 days) complications were seen in one (1.8%) patient in the LC group and in 11 (29.7%) patients in the LCOC group, for a total of 12 (12.76%) patients. The rate of early complications was significantly higher in the LCOC group than in the LC group (p ≤ 0.001). Surgical site infection at the umbilical trocar site occurred in one patient after discharge from the LC. The patient was followed up as an outpatient with daily dressing and antibiotics. Perioperative duodenal serosal injury (n = 1), five patients had pulmonary complications (atelectasis and pneumonia) (n = 5), three patients had surgical site infection (n = 3), postoperative intra-abdominal collection (n = 1), and postoperative biliary fistula (n = 1). A patient with a biliary fistula underwent ERCP during hospitalization. The patient who had a collection at the operation site was re-hospitalized, a catheter was inserted into the existing collection, and drainage was performed by an interventional radiologist. Among the patients with early complications (n = 12), only one patient (8.3%) required rehospitalization after discharge, and the other 11 patients (91.7%) had early complications during their first hospitalization, either intraoperatively or in the early postoperative period. Late complications were observed in four (4.25%) patients: one (1.8%) patient with LC and three (8.7%) with LCOC. Late complications included trocar site hernia in one patient with LC and incisional hernia in the right subcostal incision site in three patients with LCOC. No statistically significant difference was found between the groups in terms of late complication rate (p = 0.136). The early and late postoperative complications are summarized in Table 3. The median postoperative hospital stay was 1 day (2–5 days) in the LC group and 4 days (2–14 days) in the LCOC group. The length of hospital stay was shorter in the LC group than in the LCOC group (p < 0.001). No mortality was observed in any patient during the early postoperative period. Discussion XGC, with an incidence of 0.7–13.2%, is a rare variant of chronic cholecystitis [6,7]. Although studies have reported that there may be differences in XGC between genders, many studies have reported a male-dominant distribution [7,8]. Patients are usually predisposed to acute or chronic cholecystitis, which can often be confused with a primary malignancy of the gallbladder [9,10]. It is difficult to distinguish XGC from malignant processes because of its radiological (ultrasonographic or computed tomography) or intraoperative macroscopic appearance [9]. Due to its clinical and radiological similarity to gallbladder malignancy, unnecessary extensive resections may be performed during the surgical treatment of XGC [3]. The relationship between the intensity of inflammation, NLR, and PLR has been associated with many different benign and malignant diseases in various studies. In these diseases, inflammatory parameters are classified to predict the severity of the current disease status, duration of the operation, type and duration of the operation, and duration of postoperative hospital stay [11]. Many studies have reported that increased NLR and PLR ​​are associated with a high risk of complications and prolonged hospital stay [12]. In our study, we observed that the increased NLR and PLR parameters in these inflammatory processes did not differ between the groups. We think that this may be due to the fact that intense inflammation underlies XGC disease. LC is the gold standard surgical method for the treatment of benign gallbladder diseases. With this minimally invasive surgical method, patients have a shorter hospital stay and return to work [13,14]. The increased inflammatory response seen in XGC and the resulting fibrosis cause asymmetric thickening of the gallbladder wall. This progressive inflammation extends from the gallbladder wall to surrounding tissues, such as the liver, omentum, and duodenum. This causes adhesion to surrounding tissues and the development of progressive fibrosis [15]. As a result, the surgical procedure becomes more difficult than cholecystectomies performed for other benign reasons. Therefore, LC, which is the gold standard in the treatment of XGC, results in a higher rate of conversion to open surgery than classical cholecystectomy, which is performed secondary to other benign causes [16]. In our study, this situation was found to favor LC. The fact that patients who were started on conventional surgery for preoperative gallbladder malignancy, who underwent emergency surgery for acute cholecystitis, and who underwent subtotal cholecystectomy may have been excluded from our study may have been a factor in the observation of this result. The fact that we performed cholecystectomy in patients diagnosed with acute cholecystitis within the first seven days may be due to frequent encounters with a patient group with high inflammation and fibrosis [17,18]. With increasing laparoscopic surgery experience, the frequent occurrence of intense fibrosis may have resulted in a lower rate of iatrogenic injury in patients. Despite the challenges associated with XGC, our study suggests that LC can be successfully performed in the majority of cases, with better outcomes in terms of early complications and hospital stay. Conclusion Preoperative inflammatory markers are insufficient to predict the surgical approach, and laparoscopic surgery can be successfully performed in many XGC cases with better short-term outcomes while acknowledging the high conversion rate. Limitations The single-center nature of the study, relatively small sample size, lack of long-term follow-up data, and retrospective design may have introduced biases that could have affected the strength of the conclusions. The fact that the operation was performed by different surgeons and the individual decision-making processes may differ in the conversion from laparoscopic to open surgery is a limitation of the study. References Makimoto S, Takami T, Hatano K, Kataoka N, Yamaguchi T, Tomita M, et al. Xanthogranulomatous cholecystitis: a review of 31 patients. Surg Endosc. 2021;35(7):3874-3880. doi: 10.1007/s00464-020-07828-6. Hale MD, Roberts KJ, Hodson J, Scott N, Sheridan M, Toogood GJ. Xanthogranulomatous cholecystitis: A European and global perspective. HPB (Oxford) 2014;16:448–458. Díez Ares JÁ, Martínez García R, Estellés Vidagany N, Peris Tomás N, Planells Roig M, Valenzuela Gras M, et al. Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study. Rev Esp Enferm Dig. 2021;113(1):41-44. doi: 10.17235/reed.2020.7282/2020. PMID: 33054305. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open. 2019;9(1):e022896. doi: 10.1136/bmjopen-2018-022896. Farhangmehr N, Menzies D. Laparoscopic cholecystectomy: from elective to urgent surgery. Laparosc Surg 2021;5:7. doi: 10.21037/ls-20-46. Yucel O, Uzun MA, Tilki M, Alkan S, Kilicoglu ZG, Goret CC. Xanthogranulomatous cholecystitis: Analysis of 108 patients. Indian J Surg 2017; 79:510. Güneş Y, Bostancı Ö, İlbar Tartar R, Battal M. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A. 2021;31(1):36-40. doi: 10.1089/lap.2020.0334. Deng YL, Cheng NS, Zhang SJ, Ma WJ, Shrestha A, Li FY, et al. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases. World J Gastroenterol. 2015;21(44):12653-9. doi: 10.3748/wjg.v21.i44.12653. Torun M, Akyüz C, Kol D, Özbay MA. Xanthogranulomatous Cholecystitis: A Retrospective Review of Clinical Diagnosis and Treatment from a Single Center. Healthcare (Basel). 2024;12(21):2184. doi: 10.3390/healthcare12212184. Arnott W, Hutchins J, Malhotra T, Ketheesan Y, Steinberg L, Carter L, Diab J, Wong K. Xanthogranulomatous cholecystitis: diagnostic complexity and review of the literature. J Surg Case Rep. 2023;2023(6):rjad308. doi: 10.1093/jscr/rjad308. Moloney BM, Waldron RM, O' Halloran N, Kelly ME, Myers E, Garvin JT, et al. The clinical utility of pre-operative neutrophil-to-lymphocyte ratio as a predictor of outcomes in patients undergoing elective laparoscopic cholecystectomy. Ir J Med Sci. 2018;187(3):755-760. doi: 10.1007/s11845-018-1749-6. Lee SK, Lee SC, Park JW, Kim SJ. The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. BMC Surg. 2014;14:100. doi: 10.1186/1471-2482-14-100 Feng L, You Z, Gou J, Liao E, Chen L. Xanthogranulomatous cholecystitis: experience in 100 cases. Ann Transl Med. 2020;8(17):1089. doi: 10.21037/atm-20-5836. PMID: 33145308; PMCID: PMC7575994. Takeda Y, Tomimaru Y, Yokota Y, Noguchi K, Noura S, Imamura H, et al. (2019) Outcomes of laparoscopic cholecystectomy for xanthogranulomatous cholecystitis. Mol Clin Oncol 11(3):279–284 Alotaibi AM, Almasoudi E, Ahmed H, Alzwaihiri A. The incidental finding of xanthogranulomatous cholecystitis: a report of 10 cases. J Surg Case Rep. 2022 Sep 20;2022(9):rjac443. doi: 10.1093/jscr/rjac443. Qasaimeh GR, Matalqah I, Bakkar S, Al Omari A, Qasaimeh M. Xanthogranulomatous cholecystitis in the laparoscopic era is still a challenging disease. J Gastrointest Surg 2015;19:1036–1042. Sert İ, İpekci F, Engin Ö, Karaoğlan M, Çetindağ Ö. Outcomes of early cholecystectomy (within 7 days of admission) for acute cholecystitis according to diagnosis and severity grading by Tokyo 2013 Guideline. Turk J Surg. 2017;33(2):80-86. doi: 10.5152/UCD.2016.3305 Kilinc Tuncer G, Tuncer K, Sert I, Emiroglu M. Effect of Early Versus Delayed Laparoscopic Cholecystectomy on Postoperative Morbidity and Difficult Cholecystectomy in Patients With Grade II Cholecystitis According to Tokyo 2018 Guidelines: A Prospective Study. Am Surg. 2023 Dec;89(12):5775-5781. doi: 10.1177/00031348231175113. Tables Table 1. Demographic characteristics of patients Variables Laparoscopic cholecystectomy (LC) (n=57, %60,6) Laparoscopic converted to open cholecystectomy (LCOC) (n=37, %39,4) p value Age (Median) 51 (min 27-76) 59 (min 26-76) 0,167 Gender Female 27 (%47,4) 21 (%56,8) 0,374 Male 30 (%52,6) 16 (%43,2) Operation time (median) 90 min (30-200) 125min (75-255) <0,001 Duration of hospitalization (Median) 2 days (1-5) 4 days (2-14) <0,001 Postoperative early(<30day) complication Yes 1 (%1,8) 11 (%29,7) 30day) complication Yes 1 (%1,8) 3 (%8,1) 0,136 No 56 (%98,2) 34 (%91,9) Table 2. Relationship between preoperative laboratory parameters of patients and type of surgery Preoperative laboratory parameters Laparoscopic cholecystectomy (LC) (n=57) Laparoscopic converted to open surgery (LCOS) (n=37) p value White blood cell (μL) (median) (min-max) 8400 (4300-20000) 8200 (3700-25100) 0,728 Neutrophil (μL) (median) (min-max) 5200 (2200-15900) 4700(2200-22100) 0,476 Neutrophil/Lymphocyte Ratio (median) (min-max) 2,33 (0,84-19,88) 2,05 (0,87-17,75) 0,682 Platelet/Lymphocyte Ratio (median) (min-max) 120,5 (30,25-352,50) 123,52 (60,31-577,5) 0,991 Table 3. Early and late postoperative complications depending on the type of surgery Postoperative early(30day) complications Laparoscopic cholecystectomy (LC) (n=57) *surgical site infection (umbilicus trocar site) (n=1) *trocar site hernia (n=1) Laparoscopic converted to open cholecystectomy (LCOC) (n=37) *duodenal serosal injury (n=1) *pulmonary complications (atelectasis and pneumonia) (n=5) *surgical site infection (n=3) *biliary fistula (n=1) *intraabdominal collection *incisional hernia in the right subcostal incision site (n=3) Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5717540","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":394710524,"identity":"5af28f09-2ce5-485d-86d4-28a53a715652","order_by":0,"name":"Semra Demirli Atici","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYJACCRDiY2Y+BuaxsROrhY2ZLY2BIQGohZk4LUCVDDxmYC0MhLTITzv78MbHHIt8Nnaebw8+/tgmz8fMwPjhYw5uLQa3040tZ26TsGxj5t1uOCPhtmEbMwOz5MxteLRIp7FJ826TMGBj5t0mzZNwmxGoBcTG47DZQC1/wVp4noG02BPUwnAbqIURooUNpCWRoBaD22nMlr1gLWxmkjPSbie3MTM24/UL0GGMN35uqzPg5z/8TOKDzW3b+e3NBz98xOcwLICxgTT1o2AUjIJRMAowAAA+PUCMC04/cgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-8287-067X","institution":"Acibadem Kent Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Semra","middleName":"Demirli","lastName":"Atici","suffix":""},{"id":394710525,"identity":"0e4e3fba-4d8c-44b6-bbb1-fbe44b87565d","order_by":1,"name":"Ufuk Uylas","email":"","orcid":"https://orcid.org/0000-0003-4195-5498","institution":"University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Uylas","suffix":""},{"id":394710526,"identity":"9c0ed68b-1487-47d4-8f9c-d787793aff3b","order_by":2,"name":"Erdinc Kamer","email":"","orcid":"https://orcid.org/0000-0002-5084-5867","institution":"University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Erdinc","middleName":"","lastName":"Kamer","suffix":""}],"badges":[],"createdAt":"2024-12-26 17:52:18","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-5717540/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5717540/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72685880,"identity":"9af9b528-501e-4b5e-a55f-a045c74be25e","added_by":"auto","created_at":"2024-12-31 08:22:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":282369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5717540/v1/a873f499-0405-4cc4-833f-58c611654010.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eIs there a relationship between surgical technique and postoperative complication rates in xanthogranulomatous cholecystitis? A retrospective single center study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eXanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease that can be focally or widely seen in the gallbladder and is difficult to diagnose and treat [1]. This condition, a rare variant of chronic cholecystitis, is often benign [2]. The definitive treatment is surgery; it has been reported that the rate of open cholecystectomy or laparoscopy converted to open cholecystectomy (LCOC) is high [3]. The type of surgical procedure performed for XGC, which is difficult to diagnose preoperatively (extensive resection or subtotal cholecystectomy), may lead to increased surgical morbidity and prolonged hospital stay [2]. The use of laboratory parameters, such as the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), in predicting inflammatory processes has become increasingly common in recent years. These parameters have been associated with processes such as morbidity, mortality, prolonged operation time, and hospital stay in many diseases [4].\u003c/p\u003e \u003cp\u003eThe primary aim of our study was to determine the relationship between the type of surgery performed in patients diagnosed with XGC and the rates of early and late postoperative complications. The secondary aim was to determine the relationship between preoperative laboratory and inflammatory parameters of the patient and the type of surgery performed in patients diagnosed with XGC.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThe data of patients who underwent elective surgery for cholelithiasis at the Department of General Surgery of the University of Health Sciences Tepecik Training and Research Hospital between 2010 and 2020 were retrospectively scanned using the hospital automation system. A total of 9248 patients who underwent surgery were analyzed.\u003c/p\u003e \u003cp\u003ePatients aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years, those who underwent emergency surgery for acute cholecystitis, open surgery, open or laparoscopic subtotal cholecystectomy, different surgical interventions performed together with cholecystectomy (choledochal exploration, hepatectomy, hernia repair, or colectomy), pregnant patients, and those with incomplete medical records were excluded from the study. Patients aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years who underwent elective surgery for cholelithiasis, confirmed by preoperative radiological imaging (abdominal ultrasonography, abdominal computed tomography, or magnetic resonance imaging), laparoscopic cholecystectomy (LC), or did not undergo different surgical interventions (choledochal exploration, hepatectomy, hernia repair, or colectomy) together with cholecystectomy, and were converted to open laparoscopic techniques were included in the study. Operations performed by surgeons who performed more than 40 LC per year were included in the study because it is recommended that a surgeon should perform a minimum of 200 LC over 5 years (i.e., 40 cases per year) to minimize morbidity and improve outcomes [5]. Patients with a histopathologically confirmed diagnosis of XGC, who met the inclusion criteria, were analyzed. The patients were divided into two groups based on the type of surgery: LC and LCOC. The demographic characteristics of the patients (age and sex), preoperative laboratory parameters, type of operation, operation time, length of hospital stay, readmission within 30 days of surgery, and postoperative early (\u0026lt;\u0026thinsp;30 days) and late (\u0026gt;\u0026thinsp;30 days up to 6 months) morbidity and mortality were recorded.\u003c/p\u003e \u003cp\u003e This retrospective study was approved by the Clinical Research Ethics Committee of the University of Health Sciences, Tepecik Training and Research Hospital (Decision Number: 2021/05\u0026ndash;08). This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using the IBM SPSS Statistics software, SPSS v26.0. For descriptive statistics, the number of individuals (n), percentage (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and median (Q1\u0026ndash;Q3) were calculated. Pearson\u0026rsquo;s Chi-square tests were used to evaluate categorical variables. The results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). In the comparisons of continuous variables between the two groups, the Independent Samples T-test was used for variables with normal distribution, and the Mann\u0026ndash; Whitney U test was used for variables that did not fit a normal distribution. Univariate analysis was performed to identify potential risk factors, and multivariate analysis was performed to identify independent factors. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eXGC was detected in 127 (%1.37) of the 9248 cholecystectomy specimens. The patients who met the inclusion criteria included 48 female and 46 male (n\u0026thinsp;=\u0026thinsp;94) and were retrospectively analyzed. The mean age of the patients was 54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.043 years. The female-to-male ratio is 0.982. There were 27 females (47.4%) and 30 males (52.6%) in the LC group and 21 females (56.8%) and 16 males (43.2%) in the LCOC group, respectively. There was no statistically significant difference in the sex distribution between the groups (p\u0026thinsp;=\u0026thinsp;0.374). The demographic characteristics of the patients are summarized in Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eAll patients underwent radiological examination before surgery to confirm the presence of gallstones or sludge. All patients (n\u0026thinsp;=\u0026thinsp;94) who met the inclusion criteria were started laparoscopically. 57 (60.7%) patients underwent laparoscopic surgery and 37 (39.3%) underwent open surgery. The median operation time was 90 min (30\u0026ndash;200 min) for LC and 125 min (75\u0026ndash;255 min) for LCOC. The operation time for LC was shorter than that for LCOC (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;1). When the preoperative laboratory parameters and values ​​indicating inflammatory processes were compared between groups, no significant differences were observed. The parameters are listed in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003ePostoperative complications were evaluated under two subheadings: early and late. Early postoperative (\u0026lt;\u0026thinsp;30 days) complications were seen in one (1.8%) patient in the LC group and in 11 (29.7%) patients in the LCOC group, for a total of 12 (12.76%) patients. The rate of early complications was significantly higher in the LCOC group than in the LC group (p\u0026thinsp;\u0026le;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eSurgical site infection at the umbilical trocar site occurred in one patient after discharge from the LC. The patient was followed up as an outpatient with daily dressing and antibiotics.\u003c/p\u003e \u003cp\u003ePerioperative duodenal serosal injury (n\u0026thinsp;=\u0026thinsp;1), five patients had pulmonary complications (atelectasis and pneumonia) (n\u0026thinsp;=\u0026thinsp;5), three patients had surgical site infection (n\u0026thinsp;=\u0026thinsp;3), postoperative intra-abdominal collection (n\u0026thinsp;=\u0026thinsp;1), and postoperative biliary fistula (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003eA patient with a biliary fistula underwent ERCP during hospitalization. The patient who had a collection at the operation site was re-hospitalized, a catheter was inserted into the existing collection, and drainage was performed by an interventional radiologist.\u003c/p\u003e \u003cp\u003eAmong the patients with early complications (n\u0026thinsp;=\u0026thinsp;12), only one patient (8.3%) required rehospitalization after discharge, and the other 11 patients (91.7%) had early complications during their first hospitalization, either intraoperatively or in the early postoperative period.\u003c/p\u003e \u003cp\u003eLate complications were observed in four (4.25%) patients: one (1.8%) patient with LC and three (8.7%) with LCOC. Late complications included trocar site hernia in one patient with LC and incisional hernia in the right subcostal incision site in three patients with LCOC. No statistically significant difference was found between the groups in terms of late complication rate (p\u0026thinsp;=\u0026thinsp;0.136). The early and late postoperative complications are summarized in Table\u0026nbsp;3.\u003c/p\u003e \u003cp\u003eThe median postoperative hospital stay was 1 day (2\u0026ndash;5 days) in the LC group and 4 days (2\u0026ndash;14 days) in the LCOC group. The length of hospital stay was shorter in the LC group than in the LCOC group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No mortality was observed in any patient during the early postoperative period.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eXGC, with an incidence of 0.7\u0026ndash;13.2%, is a rare variant of chronic cholecystitis [6,7]. Although studies have reported that there may be differences in XGC between genders, many studies have reported a male-dominant distribution [7,8]. Patients are usually predisposed to acute or chronic cholecystitis, which can often be confused with a primary malignancy of the gallbladder [9,10]. It is difficult to distinguish XGC from malignant processes because of its radiological (ultrasonographic or computed tomography) or intraoperative macroscopic appearance [9]. Due to its clinical and radiological similarity to gallbladder malignancy, unnecessary extensive resections may be performed during the surgical treatment of XGC [3].\u003c/p\u003e \u003cp\u003eThe relationship between the intensity of inflammation, NLR, and PLR has been associated with many different benign and malignant diseases in various studies. In these diseases, inflammatory parameters are classified to predict the severity of the current disease status, duration of the operation, type and duration of the operation, and duration of postoperative hospital stay [11]. Many studies have reported that increased NLR and PLR ​​are associated with a high risk of complications and prolonged hospital stay [12]. In our study, we observed that the increased NLR and PLR parameters in these inflammatory processes did not differ between the groups. We think that this may be due to the fact that intense inflammation underlies XGC disease.\u003c/p\u003e \u003cp\u003eLC is the gold standard surgical method for the treatment of benign gallbladder diseases. With this minimally invasive surgical method, patients have a shorter hospital stay and return to work [13,14]. The increased inflammatory response seen in XGC and the resulting fibrosis cause asymmetric thickening of the gallbladder wall. This progressive inflammation extends from the gallbladder wall to surrounding tissues, such as the liver, omentum, and duodenum. This causes adhesion to surrounding tissues and the development of progressive fibrosis [15]. As a result, the surgical procedure becomes more difficult than cholecystectomies performed for other benign reasons. Therefore, LC, which is the gold standard in the treatment of XGC, results in a higher rate of conversion to open surgery than classical cholecystectomy, which is performed secondary to other benign causes [16]. In our study, this situation was found to favor LC. The fact that patients who were started on conventional surgery for preoperative gallbladder malignancy, who underwent emergency surgery for acute cholecystitis, and who underwent subtotal cholecystectomy may have been excluded from our study may have been a factor in the observation of this result.\u003c/p\u003e \u003cp\u003eThe fact that we performed cholecystectomy in patients diagnosed with acute cholecystitis within the first seven days may be due to frequent encounters with a patient group with high inflammation and fibrosis [17,18]. With increasing laparoscopic surgery experience, the frequent occurrence of intense fibrosis may have resulted in a lower rate of iatrogenic injury in patients. Despite the challenges associated with XGC, our study suggests that LC can be successfully performed in the majority of cases, with better outcomes in terms of early complications and hospital stay.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePreoperative inflammatory markers are insufficient to predict the surgical approach, and laparoscopic surgery can be successfully performed in many XGC cases with better short-term outcomes while acknowledging the high conversion rate.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe single-center nature of the study, relatively small sample size, lack of long-term follow-up data, and retrospective design may have introduced biases that could have affected the strength of the conclusions. The fact that the operation was performed by different surgeons and the individual decision-making processes may differ in the conversion from laparoscopic to open surgery is a limitation of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMakimoto S, Takami T, Hatano K, Kataoka N, Yamaguchi T, Tomita M, et al. Xanthogranulomatous cholecystitis: a review of 31 patients. Surg Endosc. 2021;35(7):3874-3880. doi: 10.1007/s00464-020-07828-6.\u003c/li\u003e\n\u003cli\u003eHale MD, Roberts KJ, Hodson J, Scott N, Sheridan M, Toogood GJ. Xanthogranulomatous cholecystitis: A European and global perspective. HPB (Oxford) 2014;16:448\u0026ndash;458.\u003c/li\u003e\n\u003cli\u003eD\u0026iacute;ez Ares J\u0026Aacute;, Mart\u0026iacute;nez Garc\u0026iacute;a R, Estell\u0026eacute;s Vidagany N, Peris Tom\u0026aacute;s N, Planells Roig M, Valenzuela Gras M, et al. Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study. Rev Esp Enferm Dig. 2021;113(1):41-44. doi: 10.17235/reed.2020.7282/2020. PMID: 33054305.\u003c/li\u003e\n\u003cli\u003eShen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open. 2019;9(1):e022896. doi: 10.1136/bmjopen-2018-022896.\u003c/li\u003e\n\u003cli\u003eFarhangmehr N, Menzies D. Laparoscopic cholecystectomy: from elective to urgent surgery. Laparosc Surg 2021;5:7. doi: 10.21037/ls-20-46.\u003c/li\u003e\n\u003cli\u003eYucel O, Uzun MA, Tilki M, Alkan S, Kilicoglu ZG, Goret CC. Xanthogranulomatous cholecystitis: Analysis of 108 patients. Indian J Surg 2017; 79:510.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;neş Y, Bostancı \u0026Ouml;, İlbar Tartar R, Battal M. Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended? J Laparoendosc Adv Surg Tech A. 2021;31(1):36-40. doi: 10.1089/lap.2020.0334.\u003c/li\u003e\n\u003cli\u003eDeng YL, Cheng NS, Zhang SJ, Ma WJ, Shrestha A, Li FY, et al. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases. World J Gastroenterol. 2015;21(44):12653-9. doi: 10.3748/wjg.v21.i44.12653.\u003c/li\u003e\n\u003cli\u003eTorun M, Aky\u0026uuml;z C, Kol D, \u0026Ouml;zbay MA. Xanthogranulomatous Cholecystitis: A Retrospective Review of Clinical Diagnosis and Treatment from a Single Center. Healthcare (Basel). 2024;12(21):2184. doi: 10.3390/healthcare12212184.\u003c/li\u003e\n\u003cli\u003eArnott W, Hutchins J, Malhotra T, Ketheesan Y, Steinberg L, Carter L, Diab J, Wong K. Xanthogranulomatous cholecystitis: diagnostic complexity and review of the literature. J Surg Case Rep. 2023;2023(6):rjad308. doi: 10.1093/jscr/rjad308.\u003c/li\u003e\n\u003cli\u003eMoloney BM, Waldron RM, O\u0026apos; Halloran N, Kelly ME, Myers E, Garvin JT, et al. The clinical utility of pre-operative neutrophil-to-lymphocyte ratio as a predictor of outcomes in patients undergoing elective laparoscopic cholecystectomy. Ir J Med Sci. 2018;187(3):755-760. doi: 10.1007/s11845-018-1749-6.\u003c/li\u003e\n\u003cli\u003eLee SK, Lee SC, Park JW, Kim SJ. The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study. BMC Surg. 2014;14:100. doi: 10.1186/1471-2482-14-100\u003c/li\u003e\n\u003cli\u003eFeng L, You Z, Gou J, Liao E, Chen L. Xanthogranulomatous cholecystitis: experience in 100 cases. Ann Transl Med. 2020;8(17):1089. doi: 10.21037/atm-20-5836. PMID: 33145308; PMCID: PMC7575994.\u003c/li\u003e\n\u003cli\u003eTakeda Y, Tomimaru Y, Yokota Y, Noguchi K, Noura S, Imamura H, et al. (2019) Outcomes of laparoscopic cholecystectomy for xanthogranulomatous cholecystitis. Mol Clin Oncol 11(3):279\u0026ndash;284\u003c/li\u003e\n\u003cli\u003eAlotaibi AM, Almasoudi E, Ahmed H, Alzwaihiri A. The incidental finding of xanthogranulomatous cholecystitis: a report of 10 cases. J Surg Case Rep. 2022 Sep 20;2022(9):rjac443. doi: 10.1093/jscr/rjac443.\u003c/li\u003e\n\u003cli\u003eQasaimeh GR, Matalqah I, Bakkar S, Al Omari A, Qasaimeh M. Xanthogranulomatous cholecystitis in the laparoscopic era is still a challenging disease. J Gastrointest Surg 2015;19:1036\u0026ndash;1042.\u003c/li\u003e\n\u003cli\u003eSert İ, İpekci F, Engin \u0026Ouml;, Karaoğlan M, \u0026Ccedil;etindağ \u0026Ouml;. Outcomes of early cholecystectomy (within 7 days of admission) for acute cholecystitis according to diagnosis and severity grading by Tokyo 2013 Guideline. Turk J Surg. 2017;33(2):80-86. doi: 10.5152/UCD.2016.3305\u003c/li\u003e\n\u003cli\u003eKilinc Tuncer G, Tuncer K, Sert I, Emiroglu M. Effect of Early Versus Delayed Laparoscopic Cholecystectomy on Postoperative Morbidity and Difficult Cholecystectomy in Patients With Grade II Cholecystitis According to Tokyo 2018 Guidelines: A Prospective Study. Am Surg. 2023 Dec;89(12):5775-5781. doi: 10.1177/00031348231175113.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic characteristics of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eLaparoscopic\u003c/p\u003e\n \u003cp\u003echolecystectomy (LC)\u003cbr\u003e\u0026nbsp;(n=57, %60,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLaparoscopic converted to open cholecystectomy (LCOC)\u003cbr\u003e\u0026nbsp;(n=37, %39,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eAge (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e51 (min 27-76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e59 (min 26-76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0,167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e27 (%47,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (%56,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0,374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e30 (%52,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 (%43,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eOperation time (median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e90 min (30-200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e125min (75-255)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDuration of hospitalization (Median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2 days (1-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 days (2-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePostoperative early(\u0026lt;30day) complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1 (%1,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (%29,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e56 (%98,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e26 (%70,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePostoperative late (\u0026gt;30day) complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1 (%1,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (%8,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;0,136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e56 (%98,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (%91,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. Relationship between preoperative laboratory parameters of patients and type of surgery\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePreoperative\u0026nbsp;\u003cbr\u003e\u0026nbsp;laboratory parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLaparoscopic\u003c/p\u003e\n \u003cp\u003echolecystectomy (LC) (n=57)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLaparoscopic converted to open surgery (LCOS) (n=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;p value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWhite blood cell (\u0026mu;L)\u003cbr\u003e\u0026nbsp;(median) (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8400 (4300-20000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8200 (3700-25100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNeutrophil (\u0026mu;L)\u003cbr\u003e\u0026nbsp;(median) (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e5200 (2200-15900)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4700(2200-22100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNeutrophil/Lymphocyte Ratio\u0026nbsp;\u003cbr\u003e\u0026nbsp;(median) (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2,33 (0,84-19,88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2,05 (0,87-17,75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePlatelet/Lymphocyte Ratio\u003cbr\u003e\u0026nbsp;(median) (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e120,5 (30,25-352,50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e123,52 (60,31-577,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0,991\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Early and late postoperative complications depending on the type of surgery\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePostoperative early(\u0026lt;30day) complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePostoperative late(\u0026gt;30day) complications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Laparoscopic\u003c/p\u003e\n \u003cp\u003echolecystectomy (LC) (n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;*surgical site infection\u0026nbsp;\u003cbr\u003e\u0026nbsp;(umbilicus trocar site) (n=1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;*trocar site hernia (n=1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Laparoscopic converted to open cholecystectomy (LCOC) (n=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;*duodenal serosal injury (n=1)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;*pulmonary complications\u003cbr\u003e\u0026nbsp;(atelectasis and pneumonia) (n=5)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;*surgical site infection (n=3)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;*biliary fistula (n=1)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e*intraabdominal collection\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e*incisional hernia in the right subcostal incision site (n=3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Xanthogranulomatous cholecystitis, subtotal cholecystectomy, gallbladder cancer, acute cholecystitis, laparoscopic cholecystectomy","lastPublishedDoi":"10.21203/rs.3.rs-5717540/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5717540/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to compare the relationship between type of surgery and preoperative findings and postoperative (early and late) complications in patients with xanthogranulomatous cholecystitis (XCG).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed 127 patients with histopathologically diagnosed XGC after evaluating 9248 cholecystectomy specimens between 2010 and 2020. Patients were divided into two groups according to surgery type: laparoscopic cholecystectomy (LC) and laparoscopy converted to open cholecystectomy (LCOC). Patient demographic characteristics, preoperative laboratory parameters, operation time, and early and late postoperative complications were recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 94 patients aged 26\u0026ndash;76 years, of whom 48 (51.06%) were female and 46 (48.94%) were male. The female-to-male ratio is 0.982. No differences were found in LC and LCOC in terms of age, sex, preoperative white blood cell count, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Surgery time, length of hospital stay, and postoperative early complication rate were lower in the LC group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas no difference was observed between the postoperative late complication rates (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePreoperative inflammatory parameters for XGC are insufficient to predict the type of surgery. LC was associated with a decreased rate of early postoperative complications, whereas no difference was observed between surgery type and late postoperative complication rates.\u003c/p\u003e","manuscriptTitle":"Is there a relationship between surgical technique and postoperative complication rates in xanthogranulomatous cholecystitis? A retrospective single center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-31 08:14:00","doi":"10.21203/rs.3.rs-5717540/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"72b5b018-3f23-4e41-9c13-67d4aa8b1949","owner":[],"postedDate":"December 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42064689,"name":"General Surgery"},{"id":42064690,"name":"Surgery"}],"tags":[],"updatedAt":"2024-12-31T08:14:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-31 08:14:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5717540","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5717540","identity":"rs-5717540","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}