Factors affecting conversion rates in laparoscopic cholecystectomy: a single surgeon study
DOI:
https://doi.org/10.18203/2349-2902.isj20202073Keywords:
Laparoscopic cholecystectomy, Conversion, Open cholecystectomy, Risk factorsAbstract
Background: There is need for conversion in laparoscopic cholecystectomy (LC) in some special situation to open cholecystectomy (OC) in order to minimize intraoperative and post-operative complications. The risk factors may be patient related, the gallbladder’s pathology and the surgeon. Most studies with regards finding the risk factors for conversion in LC involved multiple surgeons which is one of the factors. Our study is prospective study where in all cholecystectomy were done by the single surgeon so as to find out other risk factors for conversion.
Methods: This was a prospective study conducted between January 2017 to 2020, where in a total 152 patients posted for LC and 27 got converted to OC. The factors analyzed were the age and sex of the patient, elective or emergency surgery, acute or chronic cholecystitis, comorbid conditions, previous abdominal surgery, post endoscopic retrograde cholangiopancreatography, intra operative adhesions, intraoperative complication like bile duct injury, bleeding from cystic artery or gall bladder bed, bile leak.
Results: Out of 152 patient 27 (17.8%) got converted to open cholecystectomy. Mean age was 48.86 with lowest 15 and highest age operated was 83 years, among them 63 (41.4%) were male and 89 (56.8%) were female. Fibrosis at Calot’s triangle, intraoperative adhesions, cirrhosis of liver and age older than 60 years, were all significantly correlated with an increased conversion rate to laparotomy.
Conclusions: The risk factors may help to predict the difficulty of the procedure. This would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
References
Karan JA, Rose GJ. Cholelithiasis and cholecystectomy. In: Maingot’s abdominal operations, Zynnel MJ, Schwartz SI, Ellis H, eds. 10th ed. New York: McGraw-Hill; 2001.
Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12397 patients. Surg L Parosc Endosc. 1992;2(3):191-8.
Keus F, Jong JA, Gooszen HG, Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Co-chrane Database Syst Rev. 2006;18(4):165-7.
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188:205-11.
Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy, a meta-analysis. Ann Surg. 1996;224:609-20.
Tang B, Cuschieri A. Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointestinal Surg. 2006;10:1081-91.
Sultan AM, Nakeeb EA, Elsehawy T. Risk factors for conversion during laparoscopic cholecystectomy: retrospective analysis of ten years' experience at a single tertiary referral centre. Dig Surg. 2013;30:51-5.
Zhang WJ, Li JM, Wu GZ. Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy. ANZ J Surg. 2008;78:973-6.
Kortram K, Reinders JS, Ramshorst B. Laparoscopic cholecystectomy for acute cholecystitis should be performed by a laparoscopic surgeon. Surg Endosc. 2010;24:2206-9.
Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS. 2010;14:476-83.
Coffin SJ, Wrenn SM, Callas PW. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surg Endosc. 2018;32:923-9.
Andrews S. Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy, 9 years audit cycle. Surgeon. 2013;11:309-12.
Lee NW, Collins J, Britt R, Britt LD. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. Am Surg. 2012;78(8):831-3.
Ghadhban AMR, Alkumasi HA, Meziad MS. Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital. Int Surg J. 2018;5(5):1640-3.
Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH. Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg. 2006;30(9):1698-704.
Berci G, Sackier JM. The Los Angeles experience with laparoscopic cholecystectomy. Am J Surg. 1991;161:382-4.
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al. The European experience with laparo- scopic cholecystectomy. Am J Surg. 1991;161:385-7.
Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, et al. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998;85:764-7.
Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993;217:233-6.
Kanaan SA, Murayama KM, Merriam LT. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res. 2002;106:20-4.
Brunt LM, Quasebarth MA, Dunnegan DL. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15:700-5.
Merriam LT, Kanaan SA, Dawes LG. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery. 1999;126:680-6.
Laycock WS, Siewers AE, Birkmeyer CM. Variation in the use of laparoscopic cholecystectomy for elderly patients with acute cholecystitis. Arch Surg. 2000;135:457-62.
Bat O. The analysis of 146 patients with difficult laparoscopic cholecystectomy. Int J Clin Exp Med. 2015;8:16127-31.
Wevers KP, Westreenen VHL, Patijin GA. Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion. Surg Laparosc Endosc Percutan Tech. 2013;23:163-6.
Elshaer M, Gravante G, Thomas K. Subtotal cholecystectomy for ‘difficult gallbladders’: systematic review and meta-analysis. JAMA Surg. 2015;150:159-68.
Yang TF, Guo L, Wang Q. Evaluation of preoperative risk factor for converting laparoscopic to open cholecystectomy: a meta-analysis. Hepatogastroenterology. 2014;61:958-65.
Rothman PJ, Burcharth J, Pommergaard HC. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery - a systematic review and meta-analysis of observational studies. Dig Surg. 2016;33:414-23.
Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167:35-9.
Ercan M, Bostanci EB, Teke Z, Karaman K, Dalgic T, Ulas M, et al. Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic cholecystectomy. J Laparoendoscopic Advanced Surg Tech. 2010;20(5):427-34.
Genc V, Sulaimanov M, Cipe G, Basceken SI, Erverdi N, Gurel M, et al. What necessitates the conversion to open cholecystectomy: a retrospective analysis of 5164 consecutive laparoscopic operations. Clinics. 2011;66(3):417-20.