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
Related Articles
- EP ID EP256181
- DOI 10.9790/0853-1609070107
- Views 87
- Downloads 0
A Study of incidence of Hospital acquired infection in oral and maxillofacial surgery ward
AIMS: The aim of this study is to determine the incidence, various risk factors, various methods of diagnosing infection, disinfection and sterilization methods, efficacy, degree of microbial contamination, severity of w...
Comparison Between Effect of Vildagliptin And Linagliptin on Glycaemic Control, Renal Function, Liver Function And Lipid Profile in Patients of T2DM Inadequately Controlled With Combination of Metformin And Glimepiride.
Objective: Type 2 diabetes mellitus(T2DM) is a progressive disease, pharmacotherapy with a single agent does not generally provide durable glycaemic control over the long time. In this study two dipeptidyl peptidase-4 in...
Comparison of Ondansetron with combination of ondansetron and dexamethasone for prevention of nausea and vomiting after Carboprost in LSCS patients under spinal anesthesia
Introduction : Carboprost is used to prevent and treat postpartum hemorrhage in pregnant patients, however it is associated with severe nausea and vomiting .This is quite discomforting for the patient and the treating ob...
Study of First Line Antibiotics in Lower Respiratory Tract Infections in Children
Lower respiratory infections are the most common infection in children. Antibiotics are the most commonly prescribed drug for children. Based on this a prospective observational study performed in Department of Paediatri...
“Diagnostic Use of Spot Urine Protein-Creatinine Ratio, Their Correlation in Quantification of Proteinuria in Hypertensive Pregnant Women”
objective was to study the correlation between Protein– creatinine ratio of spot urine sample. Correlation of the values in hypertensive pregnant females Implications and correlation with clinical scenario. Patient would...