Conversion of laparoscopic cholecystectomy to open cholecystectomy in a single center

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

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

Faridpur Medical College Journal ◽

10.3329/fmcj.v6i2.9204 ◽

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

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Laparoscopic cholecystectomy: Conversion rate and complcation

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15305 ◽

2016 ◽

Vol 18 (3) ◽

pp. 43

Author(s):

BR Malla ◽

HN Joshi ◽

N Rajbhandari ◽

YR Shakya ◽

B Karki ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Conversion To Open Surgery ◽

Calot’S Triangle ◽

Conversion Rates ◽

Conversion To Open Cholecystectomy ◽

Previous Laparotomy ◽

History Of

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

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Rate and Risk Factors for Conversion and Complications of Laparoscopic Cholecystectomy.

TAJ Journal of Teachers Association ◽

10.3329/taj.v27i2.38991 ◽

2018 ◽

Vol 27 (2) ◽

pp. 58-62

Author(s):

MM Sarker ◽

MK Sarker ◽

NA Perveen

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Open Cholecystectomy ◽

Preoperative Assessment ◽

Biliary Leakage ◽

College Hospital ◽

Excessive Bleeding ◽

Port Site Hernia ◽

Conversion To Open Cholecystectomy ◽

Operative Complications

Laparoscopic Cholecystectomy has become the gold standard for the surgical treatment of gall bladder disease, but conversion to open cholecystectomy and both operative and post operative complications are still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion and complications could help surgeons during preoperative assessment and improve the informed consent of patients. In this study we retrospectively evaluated the rate and reasons for conversion and assessed complications of our laparoscopic cholecystectomy series. We included data of 720 consecutive patients who were attempted to laparoscopic cholecystectomy between January 2008 to March 2014 at Islami Bank Medical College Hospital, Rajshahi. The study included 468 (65%) female and 252 (35%) male with mean age of 38 years (range 16-78 years). Conversion to open procedure was carried out in 58 patients with conversion rate of 8.05%. Dense and extensive adhesions were the most common reasons for conversion (21, 36. 2%). The conversion rate due to operative complications was 13.8% of all converted cases. The major operative complications were extrahepatic bile ducts injuries 2(0.3%), duodenal injury 1(0.1%), excessive bleeding 10(1.4%). The incidence of postoperative complications was 2.8%. The most common post-operative complication was wound infection (11, 1. 52%) followed by biliary leakage in 4(0.55%) patients. Delayed complications seen in our series is port site hernia (1,0.13%). Laparoscopic cholecystectomy is the preferred method even in difficult cases. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertiseTAJ 2014; 27(2): 58-62

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Evaluation of difficulties in laparoscopic cholecystectomy

Medicinski pregled ◽

10.2298/mpns1710271s ◽

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.

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Conversion from Laparoscopic to Open Cholecystectomy

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v1i1.13013 ◽

2015 ◽

Vol 1 (1) ◽

pp. 30-32 ◽

Cited By ~ 1

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

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THE CONVERSION TO OPEN SURGERY IN LAPAROSCOPIC CHOLECYSTECTOMY

Journal of Surgical Sciences ◽

10.33695/jss.v1i2.174 ◽

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.

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Laparoscopic Cholecystectomy for Acute Gallbladder Disease During Index Admission- 11 the Optimum Timing for Surgery

Journal of Surgical Sciences ◽

10.3329/jss.v16i1.14442 ◽

2013 ◽

Vol 16 (1) ◽

pp. 11-17

Author(s):

Md Ibrahim Siddique ◽

Md Atiar Rahman ◽

Md Shahadot Hossain Sheikh ◽

Khander Manzoor Murshed ◽

Samia Mubin ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Index Admission ◽

Laparoscopic Procedure ◽

Complication Rates ◽

Financial Benefit ◽

Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy, initially considered a contraindication for the treatment of acute gallbladder disease, is now being practiced for treating acute cholecystitis worldwide. The purpose of the study is to evaluate the outcome of laparoscopic procedure in the management of acute gallbladder disease during the index admission in terms of safety and feasibility, hospital stay and the rates of complications and conversion to open cholecystectomy. Methods: Between January 2009 to December 2011, 174 patients (103 female, 71 male) with median age 43.5 years (range 27-73 years) with the diagnosis of acute gallbladder disease underwent laparoscopic cholecystectomy. Diagnosis of acute cholecystitis was made from history, physical findings and ultrasound evidence of acute inflammatory changes. Results: Median time from onset of symptoms to surgery was 70 hours. Median operative time was 76.5 minutes. Conversion rate was 1.7%. Minor post-operative complications occurred in 13.5% cases of laparoscopic procedure, which did not require further intervention. Median post-operative hospital stay was 2.5 days and total length of hospital stay was median 4.4 days. There was no mortality. Conclusion: In expert hands laparoscopic cholecystectomy for acute gallbladder disease during the index admission is safe with better clinical results, shorter hospital stay and an acceptable conversion and complication rates with additional financial benefit to the patients. DOI: http://dx.doi.org/10.3329/jss.v16i1.14442 Journal of Surgical Sciences (2012) Vol. 16 (1) : 11-17

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Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis

HPB Surgery ◽

10.1155/2000/40290 ◽

2000 ◽

Vol 11 (5) ◽

pp. 319-323 ◽

Cited By ~ 22

Author(s):

M. D. Pinhas Schachter ◽

M. D. Timor Peleg ◽

M. D. Oded Cohen

Keyword(s):

Acute Pancreatitis ◽

Laparoscopic Cholecystectomy ◽

Traditional Approach ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Operating Time ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Calot’S Triangle ◽

Mild Acute Pancreatitis

The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.

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The Predictive Factors Associated with Longer Operative Time in Single-Incision Laparoscopic Cholecystectomy

Siriraj Medical Journal ◽

10.33192/smj.2021.86 ◽

2021 ◽

Vol 73 (10) ◽

pp. 672-679

Author(s):

Weerayut Thowprasert ◽

Saritphat Orrapin

Keyword(s):

Abdominal Pain ◽

Laparoscopic Cholecystectomy ◽

Predictive Factors ◽

Operative Time ◽

Single Incision ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

University Hospital ◽

Factors Associated ◽

Conversion To Open Cholecystectomy

Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the followingconditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. Atpresent, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopiccholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operativetime in SILC procedure.Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease whounderwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ recordswere reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomeswere perioperative and 3-month postoperative adverse outcomes.Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median(interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative timeof difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (bodymass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009).Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitiswere also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007).Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder werepreoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors areidentified.

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Our experience with retrograde technique in difficult laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20204674 ◽

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.

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