TY  - JOUR
TI  - Serum cholecystokinin levels can be a predictive factor  for difficult cholecystectomy: Decreased cholecystokinin  receptor levels
AB  - BACKGROUND: Laparoscopic cholecystectomy (LC) is being performed frequently in general surgery practice. Estimation of difficult  cholecystectomy is very important to take precautions against complications. Cholecystokinin (CCK) is an important enzyme for gall bladder motility. CCK receptor is the target for CCK. Fibrosis and emptying problems of gallbladder are related with difficult cholecys tectomies. We aimed to evaluate the association between plasma CCK and difficult cholecystectomy and try to explain the mechanism. METHODS: Prospective cross-sectional study was conducted on a group of patients with cholelithiasis Patients who underwent  elective cholecystectomy were classified into easy, difficult and very difficult preoperatively using LC difficulty scores. Pre-operative  gallbladder empting ratios were measured by ultrasonography. Serum C-reactive protein, and postprandial serum CCK and pancreas  polypeptide levels were measured before the operation. Operation data including operation times, adhesion scores, and complications  were collected. Tissue CCK receptor levels and tissue fibrosis scores were obtained. RESULTS: Easy, difficult, and very difficult LC (DLC) groups were consisted of 34, 28, and 8 patients, respectively. Gallbladder emp tying was 60% in easy LC group, but 15% in very DLC group. Plasma CCK levels in easy group (37.4 pg/ml) were significantly lower  than plasma CCK levels of difficult (58.6 pg/ml), and very difficult groups (66.23 pg/ml). Tissue CCK receptor levels of easy, difficult,  and very difficult were 372.4, 178.3, and 144.1 ng/100 mg, respectively. Adhesion scores and fibrosis scores of very difficult group were  significantly higher than other groups. Operation times were significantly longer in very difficult group. There were two conversions  to open in very DLC group (25%). CONCLUSION: CCK is a reliable parameter for determining the difficulty of LC. Decreased CCK receptor levels with fibrosis of  gallbladder are the probably responsible mechanism.
AU  - ACAR, Esra
AU  - Utkan, Nihat Zafer
AU  - ÇINAR, SAFFET
AU  - YILMAZ, Tonguç Utku
AU  - ERALDEMİR, FATMA CEYLA
AU  - Vural, Çiğdem
AU  - Caglayangil, Serdar
AU  - YAPRAK BAYRAK, Busra
DO  - 10.14744/tjtes.2022.96572
PY  - 2022
JO  - Ulusal Travma ve Acil Cerrahi Dergisi
VL  - 28
IS  - 7
SN  - 1306-696X
SP  - 947
EP  - 953
DB  - TRDizin
UR  - http://search/yayin/detay/1136062
ER  -