74 Not All Hot Choles Are Equal: What Every Surgeon Should Expect from Gangrenous Hot Lap Choles

Abstract Background Gangrenous cholecystitis is a necrotising progression of acute cholecystitis that significantly complicates surgical management. This study evaluated predictive factors, intraoperative characteristics, and postoperative outcomes of gangrenous gallbladders compared to non-gangrenous cases in patients undergoing emergency laparoscopic cholecystectomy in a UK district general hospital over 11 years. Method A retrospective cohort study was conducted on 785 patients who underwent emergency laparoscopic cholecystectomy between 2013 and 2024. Comparative analysis included preoperative, intraoperative, and postoperative parameters (bile leak, complications, readmission, length of stay). Results Of the 785 patients, 25 (3.2%) had gangrenous cholecystitis. These patients were significantly older (mean 62 vs 53 years; p = 0.016), more likely to be male (64% vs 34%; p = 0.002), and had higher ASA scores. Preoperative admission CRP (median 141 vs 10 mg/L; p < 0.001) and WCC (14.8 vs 10.5 ×10⁹/L; p < 0.001) were markedly elevated. Gangrenous cases were more likely to present acutely (92% vs 70%; p = 0.014) and had fewer prior admissions. Bile leak was more common in gangrenous cases (12% vs 2%; p = 0.02), while overall complication rates (20% vs 12%; p = 0.26) and 30-day readmissions (0% vs 8%; p = 0.25) were similar. CRP correlated with gangrenous status (r = 0.17). Conclusions Gangrenous cholecystitis in emergency laparoscopic cholecystectomy is associated with advanced age, male sex, acute presentation, and pronounced inflammatory response. Nonetheless, with appropriate management, overall complication and readmission rates are not significantly different from non-gangrenous cases.