This study was designed to investigate whether or not the extent of gallbladder inflammation is more severe in male patients presenting with acute cholecystitis. Sixty-nine male patients were compared with 69 female patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Both groups were comparable with regard to perioperative characteristics. Equally, there was no difference amongst both groups with respect to post-operative complications. However, extensive gallbladder inflammation in the form of gangrenous and necrotizing cholecystitis was evident in a significant majority of the male population on histopathology compared to the female population. Multivariate analysis confirmed the male gender as an independent risk factor for extensive gallbladder inflammation.
The management of patients with AC could be associated with high rates of morbidity and mortality [16,17]. Surgical outcomes may be influenced by quiet a number of factors. The extent of gallbladder inflammation has been shown to affect the rate of complications in patients undergoing LC for acute cholecystitis [6,7,11]. According to G. Croley [18] severe inflammation of the gallbladder as seen in cases of gangrenous and necrotizing cholecystitis occurs as a result of vascular compromise following sustained cystic duct obstruction. The extensive inflammatory changes in such cases are associated with significantly higher rates of morbidity when compared with uncomplicated cholecystitis [19].
Available data suggests the male gender as a risk factor for complicated LC [10,13]. However, it is not known whether or not the risk associated with the management of male patients with acute cholecystitis is secondary to the male gender per se or to the extent of gallbladder inflammation.
The differences in the extent of gallbladder inflammation seen in this study cannot be blamed on age and comorbidities since both groups were comparable with regard to age and comorbidities. This is also true for the timing of surgery since all patients were managed within the same time frame (72 h). Furthermore, there was no risk of selection bias since all patients included were consecutively recorded.
The reasons for this gender associated difference are not well understood. However, male patients may have a higher threshold for pain. It is therefore thinkable that male patients might have experienced many episodes of undiagnosed cholecystitis which might have predispose to a more severe form of inflammation.
Taken together, our results suggest the male gender to be a risk factor for severe cholecystitis. Extensive gallbladder inflammation in the form of gangrenous and necrotizing cholecystitis was evident in a significant majority of male patients compared to female patients. Although there was a statistically significant difference in the median intraoperative blood loss amongst both groups, the absolute difference was just 70 ml. Since its clinical relevance is questionable, this finding must be interpreted with caution.
The trend presented in this series should appeal for an early surgical intervention in male patients with acute cholecystitis in order to prevent possible complications due to the extensive nature of gallbladder inflammation in this subgroup.
This study is limited by its retrospective design and the small size of the study population. Therefore the trend showed in this series warrants further investigation in a prospective set-up with well designed protocols and larger patient numbers.