Is early conversion of laparoscopic to open cholecystectomy helpful in preventing iatrogenic injuries: a retrospective study from a single unit of a tertiary care centre

Abstract

Background: Gall stone disease is the commonest hepatobiliary problem which is tackled by either laparoscopic or open technique. Since the advent of laparoscopic cholecystectomy by Eric Muhne in 1985, it has become gold standard for gall bladder removal. But a surgeon must be competent enough to convert it into open procedure, provided there are on table complications. Moreover, since laparoscopic surgery has a learning curve, open procedure for any surgery is must for safety of the patient as well as the surgeon.

Methods: A retrospective study is done over a period of 4 years (January, 2015 to December, 2018) and data of 469 patients undergoing laparoscopic cholecystectomy in a single unit of Safdarjung Hospital, New Delhi, India has been collected and evaluated for conversion to open procedure on the basis of intraoperative findings. The complications noted and the intraoperative findings and the reasons of conversion to open cholecystectomy have been compared to the previous studies done.

Results: Out of total 469 cases, M:F ratio was 1:3.51. Total 40 underwent conversion to open cholecystectomy (8.54%) with M:F ratio of 1:2.07. Most common cause of conversion was dense adhesions in Calot’s triangle along with omentum and bowel. Single patient had agenesis of gall bladder. There was no iatrogenic injury to common bile duct, common hepatic duct and there were no postoperative mortalities.

Conclusions: Early conversion to open cholecystectomy is associated with lower intraoperative iatrogenic injuries and hence, lowers postoperative morbidity.