Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.

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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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Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

International Surgery Journal ◽

10.18203/2349-2902.isj20183210 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2894

Author(s):

Digvijoy Sharma ◽

Kunduru Nava Kishore ◽

Gangadhar Rao Gondu ◽

Venu Madhav Thumma ◽

Suryaramachandra Varma Gunturi ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Bladder Wall ◽

Bladder Wall Thickness ◽

Calot’S Triangle ◽

Conversion To Open Cholecystectomy ◽

Gall Bladder Wall

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness >5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p<0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness >5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

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Utility of pre-operative abdominal ultrasound to predict conversion to open cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20213985 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3007

Author(s):

Reetesh Sharma ◽

Ramesh Dumbre ◽

Arun Fernandese ◽

Deepak Phalgune

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Fluid Collection ◽

Biliary Tree ◽

Gallbladder Wall ◽

Significant Difference ◽

Conversion To Open Cholecystectomy

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy.Methods: Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

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Pre-operative factors for predicting a difficult laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20183451 ◽

2018 ◽

Vol 5 (9) ◽

pp. 2991 ◽

Cited By ~ 1

Author(s):

Rajni Bhardwaj ◽

Rajandeep Singh Bali ◽

Yawar Zahoor

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Gall Stone ◽

Gallbladder Wall ◽

Biliary Colic ◽

P Value ◽

Safe Procedure ◽

Gall Stones ◽

History Of

Background: Laparoscopic cholecystectomy is a very safe procedure yet there are instances where serious complications can be avoided and better managed if the surgeon is forewarned or prepared in advance for them. So, a need is felt to identify pre-operative parameters for anticipating a difficult cholecystectomy.Methods: This study was carried over a period of two years (2007- 2009). Patients having symptomatic cholelithiasis willing to undergo laparoscopic cholecystectomy were enrolled in the study. The following pre-operative parameters were evaluated in the study: age, sex, body mass index, history of previous abdominal surgery, history of acute cholecystitis, history of biliary colic, palpable lump in right hypochondrium, experience of the surgeon and abdominal ultrasonogram (following parameters were noted increased gallbladder wall thickness, number of stones, size of largest stone and its location).Results: Acute cholecystitis, palpable gall bladder, increased gallbladder wall thickness, biliary colic, gall stones >2 cm in size, gall stone impacted at gallbladder neck and BMI >30 kg/m2 had a significant p-value in a difficult laparoscopic cholecystectomy.Conclusions: Further research is needed to formulate a score based on the variables mentioned above to predict a difficult laparoscopic cholecystectomy and hence letting the surgeon be better prepared for any eventualities that he encounters whilst performing laparoscopic cholecystectomy.

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Evaluation of Preoperative Risk Factors for Converting Laparoscopic to Open Cholecystectomy

The American Surgeon ◽

10.1177/000313481207800815 ◽

2012 ◽

Vol 78 (8) ◽

pp. 831-833 ◽

Cited By ~ 8

Author(s):

Nathan W. Lee ◽

J. Collins ◽

R. Britt ◽

L.D. Britt

Keyword(s):

Risk Factors ◽

Abdominal Surgery ◽

Acute Cholecystitis ◽

Preoperative Diagnosis ◽

Open Cholecystectomy ◽

Gallbladder Wall ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Upper Abdominal Surgery ◽

Upper Abdominal

Performing laparoscopic cholecystectomy (LC) always carries the risk of having to convert from laparoscopic to open cholecystectomy (LOC). Being able to identify these patients preoperatively may allow better preoperative planning and lowering operative cost. All LC and LOC were performed by the Eastern Virginia Medical School Department of Surgery retrospectively identified between January 2008 and December 2009. Preoperative risk factors identified in both groups included: age, gender, body mass index greater than 30 kg/m2, diabetes mellitus, previous upper abdominal surgery, previous abdominal surgery, presence of pericholecystic fluid, gallbladder wall thickness greater than 3 mm, preoperative diagnosis of acute cholecystitis, and pancreatitis. Reasons for conversion in the LOC group were identified from the operative note. A total of 346 LC and LOC were identified. The LOC group had 41 identified with a conversion rate of 11.9 per cent. The LOC group was compared with 100 randomly chosen LC. Risk factors that reached statistical significance for conversion included advanced age, male gender, previous upper abdominal surgery, preoperative diagnosis of acute cholecystitis, and gallbladder wall thickness greater than 3 mm ( P = 0.0009). Average operative time was higher in LOC compared with open cholecystectomy (123 minutes average vs 109 minutes average). Of the reasons for conversion, the degree of inflammation was the most common (51.2%). Preoperative risk factors that were associated with need for conversion were advanced age, male gender, previous upper abdominal surgery, preoperative diagnosis of acute cholecystitis, and pericholecystitic fluid. In patients who have all of these risk factors, we recommend starting with an open cholecystectomy. This will save operative time and overall cost.

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LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

10.36106/ijsr/7502922 ◽

2019 ◽

Author(s):

Madan Goyal ◽

R K Goel

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Critical View Of Safety ◽

Recent Onset ◽

Conversion To Open Cholecystectomy ◽

Threatening Condition ◽

Life Threatening ◽

Fluid Collections ◽

A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

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Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽

10.3390/diagnostics11030383 ◽

2021 ◽

Vol 11 (3) ◽

pp. 383

Author(s):

Kojiro Omiya ◽

Kazuhiro Hiramatsu ◽

Yoshihisa Shibata ◽

Masahide Fukaya ◽

Masahiro Fujii ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Magnetic Resonance ◽

Acute Cholecystitis ◽

Signal Intensity ◽

Magnetic Resonance Cholangiopancreatography ◽

Gallbladder Wall ◽

High Signal ◽

Mri Findings ◽

Open Conversion ◽

Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

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Successful treatment of emphysematous cholecystitis by laparoscopic surgery

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab080 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Hitoshi Funahashi ◽

Tetsuya Komori ◽

Naoki Sumita

Keyword(s):

Laparoscopic Surgery ◽

Acute Cholecystitis ◽

Rare Variant ◽

Successful Treatment ◽

Gold Standard ◽

Open Cholecystectomy ◽

Gallbladder Wall ◽

Emphysematous Cholecystitis ◽

Bacterial Proliferation ◽

Calot’S Triangle

Abstract Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

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Determining the Cardiovascular Disease Risk Factor Knowledge and Related Factors Among Adults With Type 2 Diabetes Mellitus

Clinical Nursing Research ◽

10.1177/10547738211046441 ◽

2021 ◽

pp. 105477382110464

Author(s):

Emine Karaman ◽

Aslı Kalkım ◽

Banu Pınar Şarer Yürekli

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Related Factors

In this study was to determine knowledge of cardiovascular disease (CVD) risk factors and to explore related factors among adults with type 2 diabetes mellitus (DM) who have not been diagnosed with CVD. This descriptive study was conducted with 175 adults. Data were collected individual identification form and Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale. A negative correlation was found between age and CARRF-KL score. A significant difference was found between educational status and CARRF-KL score. The individuals described their health status as good, managed their condition with diet and exercise, received information from nurses, adults with DM in their family and those with no DM complications had significantly higher scores in CARRF-KL. The knowledge of an individual with DM about CVD risk factors should be assessed, CVD risks should be identified at an early stage, and individuals at risk should be subjected to screening.

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Hemophagocytic Lymphohistiocytosis: Prevalence, Risk Factors, Outcome, and Outcome-related Factors in Adult Idiopathic Inflammatory Myopathies

The Journal of Rheumatology ◽

10.3899/jrheum.190542 ◽

2019 ◽

Vol 47 (10) ◽

pp. 1532-1540 ◽

Cited By ~ 2

Author(s):

Junyu Liang ◽

Danyi Xu ◽

Chuanyin Sun ◽

Weiqian Chen ◽

Heng Cao ◽

...

Keyword(s):

Risk Factors ◽

Disease Activity ◽

Case Control Study ◽

Case Control ◽

Short Term ◽

Related Factors ◽

Term Outcome ◽

Factors Influencing ◽

Short Term Outcome ◽

Control Study

Objective.To clarify the prevalence, risk factors, outcome, and outcome-related factors of hemophagocytic lymphohistiocytosis (HLH) in patients with dermatomyositis (DM), polymyositis (PM), or clinically amyopathic dermatomyositis (CADM).Methods.Data of patients with DM, PM, or CADM who were admitted to the First Affiliated Hospital of Zhejiang University from February 2011 to February 2019 were retrospectively collected. Patients diagnosed with HLH constituted the case group. A 1:4 case-control study was performed to identify risk factors for HLH in patients with DM, PM, or CADM through comparison, univariate, and multivariate logistic regression analysis. Intragroup comparison was made among patients with HLH to identify factors influencing unfavorable short-term outcome.Results.HLH was a rare (4.2%) but fatal (77.8%) complication in patients with DM, PM, or CADM. The retrospective case-control study revealed that higher on-admission disease activity (p = 0.008), acute exacerbation of interstitial lung disease (AE-ILD, p = 0.002), and infection (p = 0.002) were risk factors for complication of HLH in patients with DM, PM, or CADM. The following intragroup comparison showed that higher on-admission disease activity (p = 0.035) and diagnosis of CADM (p = 0.039) might influence the short-term outcome of patients with HLH. However, no risk factor was identified after false discovery rate correction.Conclusion.In this study, secondary HLH was a fatal complication, with higher on-admission disease activity, AE-ILD, and infection working as risk factors. The underlying role of infection and autoimmune abnormality in HLH in connective tissue disease was subsequently noted. Clinical factors influencing the short-term outcome of patients with secondary HLH require further study.

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