Histology-based classification of acute cholecystitis severity: Surgical Implications

  • A. M. Beliaev Auckland City Hospital, Auckland, New Zealand 2
  • N. Angelo North Shore Hospital, Auckland, New Zealand
  • M. Booth North Shore Hospital, Auckland, New Zealand
  • C. Bergin Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
Keywords: laparoscopic cholecystectomy; acute cholecystitis; classification


Objective. Current classifications of acute cholecystitis (AC) severity do not relate clinical to histological severity of AC. The aims of our study were to assess the relationship between histologic gallbladder inflammation, risk of CTO and severity of peri­operative complications, and to propose a histology­based clinical classification for AC severity. 

Materiale and methods. This was a retrospective cohort study of 1762 patients who had laparoscopic cholecystectomy (LC), 472 of whom had AC confirmed on histological examination.

Results: Patients with active chronic cholecystitis and those with acute edematous cholecystitis had more than a five­fold increase in odds of CTO compared with patients with normal gallbladders and those with chronic cholecystitis, (OR = 5.1; 95% CI, 3.5 - 7.6; p < 0.00005). Patients with acute necrotizing cholecystitis had a ten­fold increase in CTO odds (OR = 10.9; 95% CI, 6.1 - 19.1; p < 0.00005). Patients with acute gangrenous and suppurative cholecystitis had more than 11­fold increase in CTO odds (OR = 11.9; 95% CI, 6.8 - 20.5; p < 0.00005) and those with pericholecystic abscess or gallbladder perforation had 25 times higher odds of CTO (OR = 25.2; 95% CI, 5.2 - 129.2; p < 0.00005). Patients with moderate­severe AC have twice the risk of CTO that patients in the mild group have (OR=2.0; 95% CI: 1.3­3.1; p = 0.003), longer durations of surgery and higher rates and severity of perioperative complications.

Conclusion. Increasing severity of histologic gallbladder inflammation corresponds with greater risk of CTO, higher rates and severity of perioperative complications.


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How to Cite
Beliaev, A. M., Angelo, N., Booth, M., & Bergin, C. (2019). Histology-based classification of acute cholecystitis severity: Surgical Implications. Klinicheskaia Khirurgiia, 86(8), 59-66. https://doi.org/10.26779/2522-1396.2019.08.59
General Problems of Surgery