A Prospective Study of Risk Factors to Predict Conversion of Laparoscopic Cholecystectomy to Open
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 9
Abstract
Background: Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors based clinical history, laboratory investigations and imaging and their association with conversion to open. With the help of accurate prediction, high risk patient may be informed before hand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately. Surgeons can also be aware about the possible complications that may arise in high risk patients. Aims and objectives: 1) To study the risk factors associated with conversion of laparoscopic cholecystectomy to open. 2) To predict conversion of laparoscopic cholecystectomy to open preoperatively in future surgeries based on preoperative risk factors. Methods: A prospective study was conducted in the Department of General Surgery at Government Rajaji Hospital, Madurai, a tertiary care centre. All patients whounderwent laparoscopic cholecystectomy (n=93) from August 2013 to September 2014 were enrolled as cases. The method for the study included screening of patients who presented with chronic calculous cholecystitis. A detailed proforma was developed to record data on clinical history, past history, laboratory investigations, ultrasound findings and post operative complications.Thirteen risk factors were evaluated and documented for each patient to analyse their association with conversion. Results : Patients who underwent laparascopic cholecystectomy were categorised into two groups namely, successful or converted for univariate and multivariate analysis. Thirteen pre-operative variables associated with risk of conversion were analysed and compared with the outcome whether underwent successful LC or converted to open surgery. Univariate analysis was carried out by computing the odds ratio ( OR) and 95% confidence interval (CI) to compare cases in successful and converted groups for each potential factor of interest. Among the preoperative variables, history of previous attacks of cholecystitis, presence of Murphy’s sign, post ERCP, elevated leucocyte count, GB wall thickness > 3mm , pericholecystic fluid collection and multiple GB calculi were found to be significantly associated with conversion to open cholecystectomy on univariate analysis. Multivariate analysis was done to identify risk factors independently associated with conversion. Patients with gall bladder wall thickness > 3mm were 5.3 times more likely to get converted to open cholecystectomy compared to patients who underwent successful laparoscopic cholecystectomy (95% CI : 1.2, 24.6). The presence of pericholecystic fluid on USG ( Odds ratio (OR) =9.6, 95% CI :2.5, 36.1) was also identified as a risk factor for conversion. Conclusion: This study has identified certain preoperative variables as risk factors for conversion of laparoscopic cholecystectomy to open in our setting. Patient factors, laboratory investigations and preoperative USG findings are helpful in prediction of conversion. Identification of these factors preoperatively might help to psychologically prepare the patients for open surgery and for prolonged convalescence.Background: Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors based clinical history, laboratory investigations and imaging and their association with conversion to open. With the help of accurate prediction, high risk patient may be informed before hand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately. Surgeons can also be aware about the possible complications that may arise in high risk patients. Aims and objectives: 1) To study the risk factors associated with conversion of laparoscopic cholecystectomy to open. 2) To predict conversion of laparoscopic cholecystectomy to open preoperatively in future surgeries based on preoperative risk factors. Methods: A prospective study was conducted in the Department of General Surgery at Government Rajaji Hospital, Madurai, a tertiary care centre. All patients whounderwent laparoscopic cholecystectomy (n=93) from August 2013 to September 2014 were enrolled as cases. The method for the study included screening of patients who presented with chronic calculous cholecystitis. A detailed proforma was developed to record data on clinical history, past history, laboratory investigations, ultrasound findings and post operative complications.Thirteen risk factors were evaluated and documented for each patient to analyse their association with conversion. Results : Patients who underwent laparascopic cholecystectomy were categorised into two groups namely, successful or converted for univariate and multivariate analysis. Thirteen pre-operative variables associated with risk of conversion were analysed and compared with the outcome whether underwent successful LC or converted to open surgery. Univariate analysis was carried out by computing the odds ratio ( OR) and 95% confidence interval (CI) to compare cases in successful and converted groups for each potential factor of interest. Among the preoperative variables, history of previous attacks of cholecystitis, presence of Murphy’s sign, post ERCP, elevated leucocyte count, GB wall thickness > 3mm , pericholecystic fluid collection and multiple GB calculi were found to be significantly associated with conversion to open cholecystectomy on univariate analysis. Multivariate analysis was done to identify risk factors independently associated with conversion. Patients with gall bladder wall thickness > 3mm were 5.3 times more likely to get converted to open cholecystectomy compared to patients who underwent successful laparoscopic cholecystectomy (95% CI : 1.2, 24.6). The presence of pericholecystic fluid on USG ( Odds ratio (OR) =9.6, 95% CI :2.5, 36.1) was also identified as a risk factor for conversion. Conclusion: This study has identified certain preoperative variables as risk factors for conversion of laparoscopic cholecystectomy to open in our setting. Patient factors, laboratory investigations and preoperative USG findings are helpful in prediction of conversion. Identification of these factors preoperatively might help to psychologically prepare the patients for open surgery and for prolonged convalescence.Background: Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors based clinical history, laboratory investigations and imaging and their association with conversion to open. With the help of accurate prediction, high risk patient may be informed before hand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately. Surgeons can also be aware about the possible complications that may arise in high risk patients. Aims and objectives: 1) To study the risk factors associated with conversion of laparoscopic cholecystectomy to open. 2) To predict conversion of laparoscopic cholecystectomy to open preoperatively in future surgeries based on preoperative risk factors. Methods: A prospective study was conducted in the Department of General Surgery at Government Rajaji Hospital, Madurai, a tertiary care centre. All patients whounderwent laparoscopic cholecystectomy (n=93) from August 2013 to September 2014 were enrolled as cases. The method for the study included screening of patients who presented with chronic calculous cholecystitis. A detailed proforma was developed to record data on clinical history, past history, laboratory investigations, ultrasound findings and post operative complications.Thirteen risk factors were evaluated and documented for each patient to analyse their association with conversion. Results : Patients who underwent laparascopic cholecystectomy were categorised into two groups namely, successful or converted for univariate and multivariate analysis. Thirteen pre-operative variables associated with risk of conversion were analysed and compared with the outcome whether underwent successful LC or converted to open surgery. Univariate analysis was carried out by computing the odds ratio ( OR) and 95% confidence interval (CI) to compare cases in successful and converted groups for each potential factor of interest. Among the preoperative variables, history of previous attacks of cholecystitis, presence of Murphy’s sign, post ERCP, elevated leucocyte count, GB wall thickness > 3mm , pericholecystic fluid collection and multiple GB calculi were found to be significantly associated with conversion to open cholecystectomy on univariate analysis. Multivariate analysis was done to identify risk factors independently associated with conversion. Patients with gall bladder wall thickness > 3mm were 5.3 times more likely to get converted to open cholecystectomy compared to patients who underwent successful laparoscopic cholecystectomy (95% CI : 1.2, 24.6). The presence of pericholecystic fluid on USG ( Odds ratio (OR) =9.6, 95% CI :2.5, 36.1) was also identified as a risk factor for conversion. Conclusion: This study has identified certain preoperative variables as risk factors for conversion of laparoscopic cholecystectomy to open in our setting. Patient factors, laboratory investigations and preoperative USG findings are helpful in prediction of conversion. Identification of these factors preoperatively might help to psychologically prepare the patients for open surgery and for prolonged convalescence.
Authors and Affiliations
Dr. P. Amutha, Dr. S. Maniselvi, Dr. Priya. D
Keywords
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- EP ID EP256181
- DOI 10.9790/0853-1609070107
- Views 52
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