A Study on the Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 5, Issue 12
Abstract
Background: Biliary diseases constitute a major portion of digestive tract disorders. Among these, gallstone disease is the most common biliary pathology. Cholecystectomy is the most commonly performed surgery for gallbladder (GB) diseases. The most common complications that occur after cholecystectomy are post-operative ileus, atelectasis, and wound infection; other rare complications include pulmonary embolus, pneumonia, myocardial infarction, biliary peritonitis, subphrenic abscess, bacterial peritonitis, and delayed hemorrhage, due to which patients are hospitalized for several days and disabled from normal activity for several months in a year. In an attempt to reduce morbidity and disability, open cholecystectomy (OC) has been replaced by minimally invasive laparoscopic cholecystectomy (LC) due to its advantages such as decreased post-operative pain and ileus, shorter hospital stay, earlier return to normal activity, earlier oral intake, and improved cosmetic result over OC. [3-8] However, there is still a substantial proportion of patients who need OC such as patients with severe cardiac disease, pulmonary disease, concomitant disease, multiple previous abdominal incisions and in whom LC cannot be successfully performed, and conversion to open surgery is required because of technical difficulties, to avoid or repair intra-operative injury, not clearly visualized anatomic relationships, or to treat associated conditions. Conversion to OC has been associated with an increased overall morbidity, surgical site and pulmonary infections, longer hospital stays, increased total cost, and dissatisfaction of the patients. [9-11] Knowledge regarding the underlying reasons for conversion could help surgeons during pre-operative assessment and obtain consent of patients with all information provided to them about the conversion to be done if required so that they could have adequate psychological preparation and planning of convalescence. The prediction of a high risk of conversion or a difficult laparoscopic procedure would also allow efficient and appropriate arrangement of the operating schedule and the availability of experienced laparoscopic surgeons for the procedure. It would also allow an earlier intra-operative decision to convert if difficulty is encountered. Study Design: The study design is of case series. Aim of the Study: The aim is to study and identify the risk factors for conversion of LC to OC in Indian conditions (Telangana) and to determine the predictive factors of conversion in patients undergoing LC. Results: This study was done prospectively over a period of 2 years, from September 2014 to September 2016, among 206 patients who underwent LC for symptomatic GB disease in all Surgical Units of Mahatma Gandhi Memorial Hospital, Warangal. Among the 206 patients in the study, 23 (11.16%) patients were converted to OC. The most common reasons for conversion are severe adhesions caused by tissue inflammation (12 patients [52%]) and inability to define anatomy due to fibrosis of Calot’s triangle (5 patients [21.7%]). Conversion to OC due to intraoperative hemorrhage occurred in three patients. Conversion was enforced due to uncontrolled bleeding from GB bed in one patient (4.35%), which occurred during diathermic dissection of GB. In another two patients (8.7%), there was uncontrolled bleeding from Calot’s triangle, which occurred during dissection of cystic duct and artery. Conversion to OC was required to achieve successful hemostasis, as they could not be controlled laparoscopically. Conversion to OC caused by injury of the common bile duct (CBD) occurred in one patient (4.35%), and the injury is identified intraoperatively and repaired over a T-tube. In one patient (4.35%), conversion to OC was required to perform CBD exploration for suspected choledocholithiasis, based on laparoscopic finding of dilated CBD; pre-operative liver function tests (LFTs) and ultrasound were normal in this patient, and intraoperative OC facility was unavailable. Conversion to OC occurred due to equipment failure in one patient (4.35%). Conversion was due to inability to establish and/or maintain sufficient pneumoperitoneum during the course of LC and due to clip applicator failure. Conclusions: (1) In this study, the following factors are identified as significant risk factors for conversion of LC to open cholecystectomy. (i) Advanced age (>60 years), (ii) obesity (body mass index >27.5 kg/m2), (iii) leukocytosis, (iv) abnormal LFT; ultrasonography findings (1) thickened GB wall >4 mm, (2) evidence of pericholecystic fluid; (v) LC done in emergency setting for acute cholecystitis; no significant risk factors: (a) Gender, (b) previous upper abdominal surgery, (c) comorbidities; (2) In patients with these risk factors, management can be improved by (i) pre-operative counseling of the patient regarding these risk factors and high chances of conversion and (ii) early conversion to OC.
Authors and Affiliations
Goparaju Shanti Kumar, Dr Ashok, Divvela Mohan Das
Keywords
Related Articles
- EP ID EP478067
- DOI -
- Views 84
- Downloads 0
Primary Tuberculosis of Glans Penis - Mimicker of Malignancy: A Case Report and Review of Literature
Tuberculosis (TB) of penis is a rare form of genitor-urinary TB. It usually presents as an ulcerative or a nodular lesion. Most of the times, the diagnosis is delayed either due to a delay in onset of voiding difficulty...
Evaluation of Quality of Life in Nasopharyngeal Carcinoma based on EORTC QLQ-H and N35 and Karnofsky Scale in Adam Malik General Hospital Medan
Introduction: Nasopharyngeal carcinoma (NPC) is a malignant epithelial cell that lines the nasopharyngeal surface and is a neck head malignancy that has received much attention due to the relatively high mortality rate....
Biophysical Scoring of the Endometrium and Intrauterine Insemination Outcome in the Patient with Infertility
Introduction: Infertility is a condition affecting the couple at its ground level – ability to reproduce. Apart from medical and social consequences, it is also having psychological consequences having spectrum of manife...
Scientific Study on Morbidity and Mortality in Late-preterm Infants in Neonatal Intensive Care Unit in Kanyakumari Government Medical College Hospital
Introduction: Late-preterm infants are infants born between 34 and 37 weeks. The morbidities are more common among these infants. They constitute around 9% of neonates. The various morbidities are due to physiological an...
Clinical Spectrum of Presentation of Obstructive Jaundice in Inflammation, Stone Disease, and Malignancy
Introduction: The initial evaluation of obstructive jaundice involves distinguishing intrahepatic and extrahepatic biliary obstruction. Clinical data such as history, physical examination, and laboratory tests have been...