Associate Consultant at Acute Care Surgery, Hamad Medical Corporation, Qatar and Consultant of General Surgery and Emergency Medicine, Syria
This systemic analysis critically evaluates the role of preoperative C-reactive protein (CRP) as a predictive biomarker for intraoperative difficulty and postoperative complications in patients undergoing laparoscopic cholecystectomy (LC), particularly in the context of acute biliary pancreatitis (ABP) and related acute biliary pathologies. The synthesis of evidence from ten recent key studies, supplemented by a broader review of the literature, establishes that preoperative CRP is a robust, readily available, and clinically significant independent predictor of adverse perioperative outcomes [1,8,27].
The analysis demonstrates a strong, dose-dependent correlation between escalating preoperative CRP concentrations and the likelihood of encountering a technically challenging surgical environment. Higher CRP levels are consistently associated with increased operative time, a greater degree of intraoperative difficulty as measured by validated scoring systems like the Nassar scale, and, most critically, a significantly elevated risk of conversion from a laparoscopic to an open procedure. The evidence reveals a spectrum of risk associated with different CRP thresholds, ranging from moderate difficulty at levels above 50 - 100 mg/L to a markedly high probability of conversion at levels exceeding 150 - 220 mg/L. This finding suggests that while a single universal cutoff is not practical, a tiered approach to risk stratification based on CRP is highly valuable [5,17,21,29,30].
Furthermore, the predictive utility of CRP extends beyond the operating room. Elevated preoperative CRP levels are identified as a significant predictor in multivariate models for the development of postoperative complications, most notably post-cholecystectomy pancreatitis. This association underscores the concept that a high preoperative CRP reflects a persistent, heightened inflammatory state that increases patient vulnerability to further insults, including those induced by surgical manipulation. Consequently, preoperative CRP also serves as a powerful independent predictor of prolonged hospital length of stay, as it forecasts both a more complex operation and a more complicated recovery [6,34,37].
This report concludes that the integration of preoperative CRP measurement into the clinical assessment of patients with ABP is essential for optimizing surgical planning, resource allocation, and patient management. It proposes a risk stratification framework to guide surgical scheduling, enhance the informed consent process by providing more accurate risk assessment, and tailor postoperative surveillance strategies. While CRP is a potent standalone marker, its predictive power can be augmented by its inclusion in multi-parameter models and through combination with other biomarkers, such as serum albumin. Future research should focus on the prospective validation of this framework and the standardization of outcome definitions to further refine the clinical application of this indispensable biomarker.
Keywords: C-Reactive Protein; Laparoscopic Cholecystectomy; Acute Biliary Pancreatitis
Ammar Alkattan. “The Predictive Utility of C-Reactive Protein in Laparoscopic Cholecystectomy for Acute Biliary Pancreatitis: A Systemic Analysis of Surgical Difficulty and Postoperative Outcomes”. EC Clinical and Medical Case Reports 9.1 (2026): 01-12.
© 2026 Ammar Alkattan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Open Access by ECronicon is
licensed under a Creative Commons Attribution
4.0 International License
Based on a work at www.ecronicon.net
