STUDY ON THE CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY OWING TO PER OPERATIVE COMPLICATIONS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 38
Abstract
BACKGROUND In the modern medical era, laparoscopic approach to surgical conditions has reached to a height that it is performed even for malignant conditions. The minimal access surgery which has grown up from minimally invasive surgery has given us the faith that nearly all surgeries can be done by laparoscopy. The first laparoscopic cholecystectomy was done by Prof. Dr. Med Erich Muhe of Germany in the year 1985. About ten lakh cholecystectomies are performed ever year, of which 96% are done by laparoscopic method. Laparoscopic cholecystectomy is the most common laparoscopic procedure. By number of studies and research works, it is stated that laparoscopic cholecystectomy is superior to conventional open method because of its advantages like smaller incisions, early recovery, less post-operative pain and hospital stay with better cosmesis. However, laparoscopic cholecystectomy also has got its own disadvantages and complications. In 1992, an NIH consensus conference held in Bethesda approved laparoscopic cholecystectomy as the treatment of choice for symptomatic cholelithiasis. Conversion to open technique is a major morbidity of laparoscopy, as it loses its supremacy over open technique once the conversion takes place. With growing experience of laparoscopic cholecystectomy and completion of the learning curve, the indications for laparoscopic cholecystectomy have been extended approaching that of open cholecystectomy. Complications of laparoscopic cholecystectomy have been minimised to as low as 2 - 6%. However, a substantial proportion of patients had to be converted to open surgery because of technical difficulties or intraoperative complications. Conversion rates of 2.6% to 14% had been described in different studies. The factor to be considered with conversion is that it should never be considered a complication, but rather a correct judgement by the surgeon. The aims of the present study are: 1. To study the incidence of conversion of laparoscopic cholecystectomy. 2. To analyse the reasons for the conversion of laparoscopic cholecystectomy owing to per operative complications likea) Arterial injury, b) Hepatobiliary tract injury, c) Dense adhesions, d) Aberrant anatomy, e) Technical issues. MATERIALS AND METHODS This prospective observational study was conducted in patients who underwent laparoscopic cholecystectomy from November 2016 to November 2017 in the Department of General Surgery, Karpagam Faculty of Medical Sciences and Research, Coimbatore. There were totally 98 patients, of which 36 were males and 62 were females. The study has been done after the patient’s informed consent. All these patients were evaluated in a proper manner as given in the proforma and had been assessed pre-operatively and operated under perfect anaesthetic fitness. This study mainly focussed on the patients who had been converted to open method. They were analysed further regarding the reasons for conversion to open method due to per-operative complications. RESULTS From November 2016 - November 2017, a total of 98 patients had undergone laparoscopic cholecystectomy in the Department of General Surgery, Karpagam Faculty of Medical Sciences and Research, Coimbatore. Out of 98 patients who underwent laparoscopic cholecystectomy, 13 patients (13.26%) were converted to open cholecystectomy owing to per-operative complications. All patients underwent cholecystectomy as an elective case. Though some morbidity was there in terms of post-operative complications, which we are not analysing, no mortality was reported. CONCLUSION After analysing the results of our study, we conclude that the incidence of conversion of laparoscopic cholecystectomy is 13.26%. The reasons for conversion in descending order of frequency are: 1. Dense adhesions (5.1%), 2. Difficult anatomy around Calot’s triangle (3.06%), 3. Arterial injury (3.06%), 4. Hepatobiliary injury (1.02%) and 5. Technical issues (1.02%).
Authors and Affiliations
Selvaraj Vishnuvarthan, Saminathan Suganya
Keywords
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- EP ID EP548047
- DOI 10.14260/jemds/2018/929
- Views 105
- Downloads 0
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