Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy

Background Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. Purpose To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. Material and Methods A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters—including demographics, clinical history, laboratory data, and CT findings—were analyzed. Results Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81–1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Conclusion Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.

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RESULTS OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH AN ACUTE CALCULUS CHOLECYSTITIS AND ISCHEMIC HEART DISEASE

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.3-4.2017.03 ◽

2018 ◽

Vol 13 (3-4) ◽

pp. 15-21

Author(s):

V.G. Mishalov ◽

S.O. Kondratenko ◽

L.Yu. Markulan

Keyword(s):

Heart Disease ◽

Laparoscopic Cholecystectomy ◽

Ischemic Heart Disease ◽

Open Cholecystectomy ◽

Group Versus ◽

Ischemic Heart ◽

Acute Calculous Cholecystitis ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion To Open Cholecystectomy ◽

Calculous Cholecystitis

Relevance. Determination of the optimal time for laparoscopic cholecystectomy (LCE) in patients with acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) is still an actual and unresolved issue. Objective: to evaluate the results early versus delayed LCE in patients with ACC and IHD. Materials and methods. The study involved 107 patients with ACC and IHD: 56 (47,7 %) women and 51 (52,3 %) men aged 55 to 82 years, an average 70,2±0,6 years. The group with early LCE (ELCE) included 48 patients with LCE – up to 72 hours from the beginning of ACC (on average 41,9±2,1 hours), the group with delayed LCE (DLCE) – 59 patients, who were LCE for more than 72 hours (in average 90,2±1,6 hours) from the beginning of ACC. Groups of patients were representative according to the functional classes of heart failure, angina pectoris, severity and the histological form of ACC. All patients had a Charlson comorbidity index from 0 to 2 points. The endpoint of the study were: the frequency of conversion to open cholecystectomy, cardiac events in the intra – and early postoperative periods, the incidence of complications according to the Clavien-Dindo classification. Data analysis was performed using IBM SPSS Statistics. Results. The duration of LCE in the DLCE group was 45,2±2,1 minutes, in the ELCE group it was 40,9±1,4 min (p=0,115). Conversion to open cholecystectomy was required in 8 (13,6 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0,033. During the operation, myocardial ischemia occurred in 17 (28,8 %) patients of the DLCE group versus 6 (12,5%) the ELCE group, p=0,041, and a systolic blood pressure decrement lower than 70 mm hg. art. – in 24 (40,7 %) against 8 (16,7 %), p=0,007; saturation reduction episodes – in 33 (55,9 %) against 17 (35,4 %), p=0,034, respectively. In the early postoperative period, an increasing of HF class according to NYHA was observed in 12 (20,3 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0.004; the number of patients with complications according to Clavien-Dindo classification – 40 (67,8 %) versus 23 (47,9 %), p=0,038; pneumonia occurred in 26 (44,1 %) against 6 (12,5 %), p=0,001; exudative pleurisy – in 28 (47,5 %) against 9 (18,8 %), p=0,002, respectively. There were no lethal cases in the period up to 7 days in both groups. Conclusion. ELCE is a priority method of treatment patients with an acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) with a different functional class (according to NYHA). Compared with DLCE, it is associated with reliable reduce of conversion (2,1 %), against 8 (13,6 %), intra- and early postoperative complications of the cardiovascular system and complications according to Clavien-Dindo classification – 23 (47,9 %) patients against 40 (67,8 %).

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Significance of Preoperative Ultrasound Measurement of Gallbladder Wall Thickness

The American Surgeon ◽

10.1177/000313480707300922 ◽

2007 ◽

Vol 73 (9) ◽

pp. 926-929 ◽

Cited By ~ 1

Author(s):

James Majeski

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Acalculous Cholecystitis ◽

Gallbladder Wall ◽

Chronic Cholecystitis ◽

Entire Series ◽

Calculous Cholecystitis ◽

Gallbladder Ultrasound

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (≥3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.

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Factors determining conversion of laparoscopic to open cholecystectomy

IMC Journal of Medical Science ◽

10.3329/imcjms.v11i2.33091 ◽

2017 ◽

Vol 11 (2) ◽

pp. 32-35

Author(s):

Tapash Kumar Maitra ◽

Mahmud Ekramullah ◽

Faruquzzaman ◽

Samiran Kumar Mondol

Keyword(s):

Risk Factors ◽

Bile Duct ◽

Abdominal Surgery ◽

Open Cholecystectomy ◽

Gallbladder Wall ◽

Cystic Artery ◽

Male And Female ◽

Previous Abdominal Surgery ◽

History Of ◽

The Mean

Background and objectives: Laparoscopic cholecystectomy (LC) has virtually replaced conventional open cholecystectomy (OC) as the standard procedure of treatment for cholelithiasis and cholecystitis. However, OC sometimes becomes a necessity considering the feasibility and safety of the surgical procedure. But the factors that demand conversion from LC to OC differ widely. The present study aimed to determine the prevalence of conversion from LC to OC and to assess the causes of conversion and risk factors related to conversion.Methods: The study was conducted in a referral hospital Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) from September 2014 to September 2016. Cases of cholelithiasis with or without cholecystitis, and other gall bladder pathology were included in the study. A team of experienced surgeon performed LC of all selected cases. The causes of conversion to OC were systematically recorded by the surgical team and the risk factors (age, sex, obesity, history of previous abdominal surgery, gallbladder thickness) related to conversion from LC to OC was investigated.Results: A total of 261 (M / F = 87 /174) patients were considered eligible for the study. The mean age of all patients was 43 (±1.75) years. For the male and female groups the mean ages were 44±1.9 and 42±1.6 years respectively. Of the total 261 cases, 210 (80.5%) patients had cholelithiasis with chronic cholecystitis, 47 (18.0%) had gallbladder stone plus acute cholecystitis and 4 (1.5%) had gallbladder polyp. Open conversion was required in case of 19 patients. Thus, overall conversion rate was 7.3%. The common causes of conversion were a) difficulty in defining Calots triangle (42.1%), b) injury to cystic artery (21.1%) and c) injury to bile duct (15.8%). Both male and female had equal risk for conversion. The investigated risk factors like history of previous abdominal surgery, preoperative ERCP, acute cholecystitis, obesity, increased gallbladder-wall thickness and older age showed no significant association with conversion.Conclusion: The study revealed that a very few patents (7.5%) needed conversion from LC to OC. The commonest cause of conversion was difficulty in defining Calots triangle, injury to cystic artery and bile duct. The risk factors like previous abdominal surgery, preoperative ERCP, gallbladder wall thickness, obesity and old age were not found associated with conversion to OC.IMC J Med Sci 2017; 11(2): 32-35

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Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20183404 ◽

2018 ◽

Vol 5 (9) ◽

pp. 2984

Author(s):

Abhishek Jina ◽

Shailendra Kumar ◽

Vineet Singh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Surgery ◽

Gall Bladder ◽

Open Cholecystectomy ◽

Total Leukocyte Count ◽

Symptomatic Cholelithiasis ◽

Upper Abdominal Surgery ◽

Study Results ◽

History Of ◽

Upper Abdominal

Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.

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FEATURES OF SURGICAL TACTICS OF TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS OCCURRING AGAINST THE BACKGROUND OF DIABETES MELLITUS

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-6-90-95 ◽

2018 ◽

Vol 25 (6) ◽

pp. 90-95

Author(s):

V. V. Zorik ◽

G. K. Karipidi ◽

A. V. Morozov

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Cholecystectomy ◽

Surgical Treatment ◽

Postoperative Complications ◽

Histological Study ◽

Open Cholecystectomy ◽

Control Group ◽

Acute Calculous Cholecystitis ◽

Patients With Diabetes ◽

Calculous Cholecystitis

Aim. The study was conducted to improve the results of the surgical treatment of acute calculous cholecystitis occurring against the background of diabetes mellitus. Materials and methods. In course of our study, we analyzed the treatment results of 687 patients with acute calculous cholecystitis. Depending on the presence of diabetes, all patients were divided into two groups. The main group with concomitant diabetes mellitus included 68 (9,9%) patients, whereas the control group without diabetes included 619 (90,1%) patients. Laparoscopic cholecystectomy was performed on 636 (92,6%) patients, and open cholecystectomy was performed on 51 (7,4%) patients. Results. According to the histological study, the greatest number of destructive forms occurs in patients with concomitant diabetes, operated after 24 hours. The least postoperative complications occur in patients of both groups operated from 12 to 24 hours. However, the incidence of complications is 4-5 times higher in patients with diabetes mellitus. Postoperative complications in patients with acute calculous cholecystitis occurring on the background of sugar diabetes were observed after open cholecystectomy in 33,3% of cases and in 6,5% of cases after laparoscopic surgery.Conclusion In patients with acute cholecystitis and concomitant diabetes, surgical treatment should be performed on the first day after the preoperative preparation during the first 12 hours, aimed at compensating for diabetes and improving microcirculation. The preference should be given to laparoscopic cholecystectomy, which reduces the number of postoperative complications by 5 times and mortality by 4.5 times.

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FACTORS ASSOCIATED WITH CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY; OUR EXPERIENCE

10.36106/6324198 ◽

2021 ◽

pp. 15-18

Author(s):

Heet Amlani ◽

Sakshi Singhal ◽

Neelkamal Gupta ◽

Jitendra K. Mangtani

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Surgery ◽

Wall Thickness ◽

Conversion Rate ◽

Intraoperative Complications ◽

Open Cholecystectomy ◽

Surgical Anatomy ◽

Previous Abdominal Surgery ◽

History Of ◽

Wbc Count

BACKGROUND:LC has become the gold standard for treating symptomatic cholelithiasis. It is important to keep in mind that the primary goal of LC is the safe removal of the GB, Therefore conversion to open should not be deemed a failure. Conversion to laparotomy may denitively be identied with surgical anatomy in difcult dissection or to address intraoperative complications such as bleeding, biliary or bowel injury. Ideally conversion should be carried out before complication arises Method and material: The present study was done on 100 patients undergoing laparoscopic cholecystectomy in the Department of General Surgery at Mahatma Gandhi Hospital. Factors(brief history, preoperative investigation and ultrasound ndings) that could help predict convertion of lap. Cholecystectomy to open were idened and were analysised with IBM.SPSS statistics software Result: Observation and analysis of all the parameters studied. Total 6 patients out of 100 cases were converted to open cholecystectomy i.e. conversion rate is 6%. Association of conversion with age was signicant. Association of BMI with conversion rate was signicant. no signicant association of acute cholecystitis with conversion rate. no signicant association of history of jaundice with conversion rate. Association of previous abdominal surgery with conversion rate was signicant. Association of wbc count with conversion rate was not signicant. There was signicant association between GB wall thickness and conversion rate. No signicant association of impacted stone with conversion rate. No signicant association of pericholecystic uid with conversion rate. Colclusion:In our study signicant correlation was found between the following parameters and conversion BMI, Previous abdominal surgery and GB wall thickness rest factors were not signicant.

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