scholarly journals Our experience with retrograde technique in difficult laparoscopic cholecystectomy

2020 ◽  
Vol 7 (11) ◽  
pp. 3691
Author(s):  
Vamsi K. Malligurki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Surgical Practice ◽  
Conversion To Open Surgery ◽  
Surgical Units ◽  
Surgical Expertise ◽  
Dissection Technique ◽  
Retrograde Technique ◽  
Difficult Cases

Background: Gall bladder pathologies are some of the commonly encountered conditions in one’s surgical practice. Cholecystectomy is among the routinely performed procedures in most surgical units. Laparoscopic surgery is preferred to open cholecystectomy because of its various advantages. In straightforward cases, the antegrade technique is routinely employed. The retrograde technique is generally reserved for the difficult cases. The retrograde technique may be used safely with adequate experience, thus reducing the need for conversion into open surgery.Methods: Total 100 cases of consecutive difficult laparoscopic cholecystectomies were included in this study, which were operated using retrograde technique.Results: Out of the 100 patients 79 were females and 21 were males. Mean age of the patients was 44.2 years. Out of the 100 cases, 98 cases could be successfully managed using the retrograde technique. 2 cases were converted to open surgery. Bleeding was encountered in 3 cases, which was successfully managed laparoscopically. Bile duct injury was seen in 1 case which was managed after conversion.Conclusions: With adequate surgical expertise and proper instrumentation, retrograde dissection technique may be safely used in difficult laparoscopic cholecystectomy, reducing the rate of conversion to open surgery.

scholarly journals Early Laparoscopic Cholecystectomy with Continuous Pressurized Irrigation and Dissection in Acute Cholecystitis

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
I. Ozsan ◽  
O. Yoldas ◽  
T. Karabuga ◽  
U. M. Yıldırım ◽  
H. Y. Cetin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Acute Cholecystitis ◽  
Symptom Onset ◽  
Open Surgery ◽  
Bile Leak ◽  
Conversion To Open Surgery ◽  
Conversion Rates ◽  
Pressurized Irrigation ◽  
Dissection Technique

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis.Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded.Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was46.3±6.7years. The median time from symptom onset to hospital admission 3.2 days (range, 1–6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group.Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.

scholarly journals Conversion of laparoscopic cholecystectomy to open cholecystectomy in a single center

2021 ◽  
Vol 9 (2) ◽  
pp. 14-18
Author(s):  
Suttam Kumar Biswas ◽  
Shilpi Rani Roy ◽  
Subbrata Sarker ◽  
Md Mustafizur Rahman ◽  
Kamrul Islam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Preoperative Assessment ◽  
College Hospital ◽  
Conversion To Open Surgery ◽  
Calot’S Triangle ◽  
Number Of Patients ◽  
Conversion To Open Cholecystectomy

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversions to open cholecystectomy are still inevitable in certain cases. Knowledge about the rate and underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion of our LC series. This study included 320 consecutive laparoscopic cholecystectomies from January 2017 to December 2019 at Community Based Medical College Hospital Bangladesh, Mymensingh. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 15 (4.6%) patients. Out of 15 cases, the highest number of patients 10(66.6%) were in age group 50 to 59 years with a mean age of 60.1 years and standard deviation (SD) of 9.8 years. Of them 9 (60%) were male. The most common reasons for conversion of them were severe adhesions at calot's triangle 6 (40%) and acutely inflamed gallbladder 5 (33.3%), bleeding 2 (13%). No surgical procedures are complication free. The most common complication was superficial wound infection 8(2.5%). Delayed complications seen in our series is port site incisional hernia 2 (0.62%). Male gender, age older than 60 years, previous upper abdominal surgery, diabetes, and severity of inflammation were all significantly correlated with an increased conversion rate to laparotomy. LC is the preferred method even in difficult cases. This study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery. CBMJ 2020 July: Vol. 09 No. 02 P: 14-18

scholarly journals Evaluation of difficulties in laparoscopic cholecystectomy

2017 ◽  
Vol 70 (9-10) ◽  
pp. 271-276
Author(s):  
Katarina Sarcev ◽  
Dimitrije Damjanov ◽  
Dijana Kosijer ◽  
Dragomir Damjanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Conversion To Open Surgery ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Group B

Introduction. For decades, laparoscopic cholecystectomy has been the gold standard in surgical treatment of patients with cholelithiasis all over the world. The main advantage of this approach is that it is a minimally invasive procedure for patients. Although this method is a routine in our country, there are certain cases where the presumed outcome of minimally invasive procedure is not achieved, and the surgery is converted to open surgery, or a subsequent laparoscopic surgery is performed, in order to deal with the complications. The aim of this study was to establish if it was possible to create a model for preoperative prediction of difficult laparoscopic cholecystectomies. Material and Methods. Two groups of patients were analyzed. Group A included patients with cholelithiasis who were studied in order to determine parameters associated with difficult laparoscopic cholecystectomies. Out of 16 analyzed parameters, 8 showed significant correlation with difficult laparoscopic cholecystectomies. Based on these parameters, a prediction model was established, consisting of five groups: I - easy (score 1), II - laparoscopic cholecystectomy with mild difficulties (score 2), III - laparoscopic cholecystectomy with major difficulties (score 3), IV - difficult (score 4), V - conversion to open surgery is expected (score 5). This model was preoperatively applied in patients with cholelithiasis included in group B. Results. The overall predictability of the model was 82%. The greatest prediction accuracy was achieved in groups II and III (98.3% and 100%, respectively). Conversion to open cholecystectomy was predicted in 76% of patients. Conclusion. Based on certain preoperative parameters it is possible to establish a model to predict a difficult laparoscopic cholecystectomy.

scholarly journals Rate of Conversion and Postoperative Complications of Laparoscopic Cholecystectomy in District Level Hospital of Bangladesh

1970 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
SK Biswas ◽  
JC Saha ◽  
ASMT Rahman ◽  
ASMZ Rahman ◽  
MM Rahman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Key Words Laparoscopic Cholecystectomy ◽  
Biliary Leakage ◽  
Conversion To Open Surgery ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy and postoperative complications are still inevitable in certain cases. Knowledge of the rate and underlying reasons for conversion and postoperative complications could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion and postoperative complications of our LC series. This study included 760 consecutive laparoscopic cholecystectomies from July 2006 to June 2011 at Faridpur Central Hospital and Faridpur Medical College Hospital. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 19 (2.5%) patients. The most common reasons for conversion were severe adhesions at calot's triangle (6, 0.83%) and acutely inflamed gallbladder (5, 0.66%). The incidence of postoperative complications was 1.58%. The most common complication was wound infection, which was seen in 5 (0.66%) patients followed by biliary leakage in 3 (0.40%) patients. Delayed complications seen in our series is port site incisional hernia (2, 0.26%). LC is the preferred method even in difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery and it should not be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon. Key words: Laparoscopic cholecystectomy (LC); Open cholecystectomy; Conversion; Complications; Calot's triangle DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9204 FMCJ 2011; 6(2): 74-77

scholarly journals Conversion from Laparoscopic to Open Cholecystectomy

2015 ◽  
Vol 1 (1) ◽  
pp. 30-32 ◽  
Author(s):  
Samir Shrestha ◽  
Surendra S Shah ◽  
Sanjay Poudyal ◽  
Jay N Shah ◽  
Vijay Kumar Jaiswal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Health Sciences ◽  
Conversion To Open Surgery ◽  
Open Conversion ◽  
Previous Abdominal Surgery ◽  
Calot’S Triangle ◽  
Duration Of Surgery

Introductions: With the advent of newer technology, the era of open surgery for gall bladder diseases has been preferably taken over by laparoscopic cholecystectomy. However, certain cases still require conversion to open surgery. In this review we aim to analyze the reason for conversion. Methods: This retrospective study was conducted at Patan Hospital, Patan Acdemy of Health Sciences, Nepal. All patients who underwent laparoscopic cholecystectomy from February 2009 to July 2012 were included in the study. File numbers of all the patients were obtained from operation room register. The patient files were analyzed for age, sex, duration of symptoms, liver function tests, ultrasound findings and the description in operation note for reason for conversion. Results: The age ranged from 12 to 81 years with mean age of patients 32.76 years and male to female ratio 1:2.9. The mean operating time was 65 minutes and average post operative hospital stay was 1.61 days. Out of 305 patients, 34 (11.14%) required open conversion. Factors responsible for open conversion were dense fibrosis at Calots in 11 (3.6%), adhesions due to previous abdominal surgery in 6 (1.9%), uncontrollable bleeding in 5 (1.6%), bile duct injury in 4 (1.3%) cholecystoenteric fistula in 3 (0.9%), Mirizzi’s syndrome 2(0.6%). Conclusions: Adhesions at the calot’s triangle was the common reason for conversion from laparoscopic to open cholecystectomy. Plain Language Summary: This study was conducted to determine the predictive factors for conversion of laparoscopic cholecystectomy. The study found that dense adhesion around calot’s triangle and adhesions pertaining to previous abdominal surgery were the main reasons for conversion to open surgery. So, before embarking on laparoscopic cholecystectomy, it is essential to take detail history and examination, to rule out the probable cause of conversion beforehand and minimize; morbidity, duration of surgery and cost. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13013 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):30-32 

scholarly journals THE CONVERSION TO OPEN SURGERY IN LAPAROSCOPIC CHOLECYSTECTOMY

2018 ◽  
Vol 1 (2) ◽  
pp. 57-61
Author(s):  
I. Slavu ◽  
V. Braga ◽  
L. Alecu
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Gold Standard ◽  
Preoperative Diagnosis ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Safe Method ◽  
Conversion To Open Surgery ◽  
Conversion To Open Cholecystectomy

After more than 20 years from the beginning of laparoscopic surgery, laparoscopic cholecystectomy still holds a conversion rate of 5.1 % in the specialty literature. We have conducted a retrospective study based on the experience of the clinical unit of General Surgery within “Prof. Dr. A. Ionescu” Emergency Clinical Hospital, between 1997 and 2013. A number of 2,309 laparoscopic cholecystectomies were performed. The average age of the group was 47.3 years. Conversion was performed to a number of 58 patients (2.51%), out of which 74.13% women (no. = 43) and 26% men (no. 15). The average age of the patients to whom the conversion was performed was 57. Conversion to open cholecystectomy was more frequent in patients over 60 (no. 38). The main preoperative diagnosis in converted patients was acute lithiasic cholecystitis. Laparoscopic cholecystectomy is a safe method with optimal results, being considered the “gold standard” in the treatment of bladder lithiasis. Conversion to open surgery is an expression of the surgeon’s experience and wisdom.

scholarly journals THE STUDY OF CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS.

2019 ◽  
pp. 1-3
Author(s):  
Dug Tariq Hassan ◽  
Rayees Ahmad Bhat ◽  
Liyaqat Nazir ◽  
Shabir Ahmad Dar ◽  
Mohammad Zakiuddin
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Medical Sciences ◽  
Preoperative Risk ◽  
Conversion To Open Surgery ◽  
Preoperative Risk Factors ◽  
Risk Scoring

BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion.However,there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints,which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. MATERIALS AND METHODS:A case control study of patients who underwent laparoscopic surgery from May 2016 to April 2017 at Shere Kashmir Institute of Medical Sciences, Srinagar. All those patients who were converted to open surgery (n = 73) were enrolled as cases.Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery. RESULTS:The final multivariate model identified two risk factors for conversion:ultrasonography signs of inflammation (adjusted odds ratio [aOR] = 8.5;95% confidence interval [CI]:3.3,21.9) and age > 60 years (aOR = 8.1;95% CI:2.9,22.2) after adjusting for physical signs,alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion

scholarly journals Comparative Study of the Effect of Laparoscopic and Open Surgery on Acute Cholecystitis

2015 ◽  
Vol 4 (3) ◽  
pp. 23
Author(s):  
Jian Lin
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Operation Time ◽  
Surgical Indications ◽  
Method Clinical Data ◽  
Function Recovery ◽  
Stay Time ◽  
Strict Condition

<strong>Objective:</strong> To compare the clinical effect of laparoscopic and open surgery on acute cholecystitis. Method: clinical data of 200 cases of acute cholecystitis patients in our hospital from July 2006 to July 2010 were divided into laparoscopic cholecystectomy(LC) group and open cholecystectomy(OC) group. Comparison was made from various aspects to show the feasibility of laparoscopic cholecystectomy of acute cholecystitis. <strong>Results:</strong> the operation time, off-bed activity time, postoperative gastrointestinal function recovery time and hospital stay time of LC group were all lower than OC group (<em>t </em>= 2.785, <em>t</em> = 2.825, <em>t</em> = 2.831, <em>t</em> = 2.904, <em>p</em> &lt; 0.05); OC group’s postoperative complications was 23.0%, higher than that (9.0%) of LC group(χ<sup>2 </sup>= 3.764, <em>p</em> &lt; 0.05). <strong>Conclusion:</strong> Under the chosen strict condition of surgical indications and delicate surgery operation, the application of laparoscopic cholecystectomy in the treatment of acute cholecystitis is safe and feasible.

scholarly journals Laparoscopic cholecystectomy in patients with liver cirrhosis: review of intraoperative measures and recommendations

2021 ◽  
Author(s):  
Tamer M. Abdelrahman
Keyword(s):  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Intraabdominal Pressure ◽  
Biliary Stones ◽  
Conversion To Open Surgery ◽  
Trocar Placement ◽  
Surgical Teams

AbstractSymptomatic biliary stones are related with higher morbidity and mortality rates in patients with liver cirrhosis, especially when patients undergo surgery. The difficulty of cholecystectomy is worsened by liver cirrhosis, especially in patients with extensive liver fibrosis and portal hypertension.Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis. However, it can be challenging in many aspects and poses a greater degree of difficulty and thus should be performed by experienced surgical teams, who follow the recommendations and take in mined the special precautions which requested to increase safety of the operation and avoid  or reduce the morbidity and mortality , and also who able to tackle the more frequent intraoperative incidents or complications.In this review, we focus on of the technical difficulties and intraoperative recommendations that could be used to approach laparoscopic cholecystectomy in this patient population (trocar placement, intraabdominal pressure, visualization, gallbladder dissection, adjunct for hemostasis, intraperitoneal drains, and conversion to open surgery), and the alternative which can be used in advanced cases  

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