Evaluation of factors leading to conversion in laparoscopic cholecystectomy
Journal Title: Medpulse International Journal of Surgery - Year 2019, Vol 9, Issue 3
Abstract
Introduction: In the modern era laparoscopic cholecystectomy is established gold standard surgery for cholecystectomy. Conversion from laparoscopic to open cholecystectomy is a step towards the safety of the patient. The knowledge of preoperative and intraoperative risk factors for conversion in laparoscopic cholecystectomy is of utmost importance to the operating surgeon. Material and Methods: This prospective study was carried out in Department of General Surgery at Dr Rajendra Prasad Government Medical College at Tanda, District Kangra, Himachal Pradesh, India. It included patients from October 2011 to March 2013 who had undergone laparoscopic cholecystectomy. Results: The overall frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy of our study was 15.33%. These conversions were significantly more in those patients where preoperative factors viz. male gender, age was more than 60 years, previous history of hospitalization for acute cholecystitis or acute pancreatitis, elevated LFTs, high T.L.C and gall bladder wall thickness more than 4 mm on ultrasonography were present. Conversions to open cholecystectomy were due to obscured anatomy as a result of dense adhesions, dense adhesions with empyema or dense adhesions with contracted gall bladder, cystic artery bleed, haemorrhage from liver, bile duct injury, anatomical anomaly, light source failure, Co2 insufflator failure and hand instrument failure. Conclusion: The identification of Preoperative and Intraoperative parameters can predict conversion and can improve preoperative patient counselling, provides for better per operative planning, optimizes operating room efficiency and helps to avoid laparoscopic-associated complications by performing an open operation when appropriate. Proper maintenance of instrument should be done to prevent the forced conversion due to machinery failure. It is vital for the surgeons and patients to appreciate that the decision to go for conversion is not failure but rather implies safe approach and sound surgical judgment. Key Words: Conversion, Intraoperative risk factors, Laparoscopic Cholecystectomy, Machinery related risk factors, Open Cholecystectomy, Preoperative risk factors.
Authors and Affiliations
Abhay Singh, Shachi . , Ramesh Bharti, Amar Verma
Keywords
Related Articles
- EP ID EP526593
- DOI 10.26611/106937
- Views 155
- Downloads 0
A cytopathological study of breast lesions at tertiary health care centre
Background: Breast lesions, both benign and malignant, are quite common in Indian population. FNAC is a cheap, fast, and reliable diagnostic method. It also reduces the frequency of open biopsies. Histological examinatio...
A study of association of lipid profile and gallstone disease at tertiary health care centre
Background: The role of serum lipids in the etiology of cholelithiasis is very important and in cholesterol gall stones serum lipids are found altered. Various studies have shown an association between gallstones and abn...
Clinico pathological study of mass in right iliac fossa
The mass can be due to intra- or extra-abdominal causes. A swelling in the right iliac fossa may arise from the structures normally present in that region or from structures, which are abnormally situated in the region....
A Single centre study of role of repeat CT scans in the treatment of traumatic brain injury
Background: Traditionally, nonoperative management of Traumatic brain injury patients with an intracranial hemorrhage (ICH) has consisted of observation and a routine repeat head CT (HCT) study at 24–48 hours after admis...
Epidemiology and risk factors of cholangiocarinoma: A study at MGM medical college, Aurangabad
Background: There are considerable geographic and demographic variations in the incidence of cholangiocarcinoma. Although it comprises only 10-15% of hepatobiliary neoplasms, its incidence is increasing. There are severa...