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

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.

scholarly journals Prediction of difficult cholecystectomy, a study of 100 cases

2018 ◽  
Vol 7 (1) ◽  
pp. 63
Author(s):  
Debananda Tudu ◽  
Bana Bihari Mishra
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Wall Thickness ◽  
Standard Procedure ◽  
Bladder Wall ◽  
Gall Stone ◽  
Medical Science ◽  
Previous Abdominal Surgery ◽  
Difficult Cholecystectomy ◽  
Wbc Count

Background: Cholelithiasis is a common problem in day to day surgical practice, which has a prevalence of 10-15%. The prevalence is more here in this part of the country as this is a pocket of sickle cell disease region. Laparoscopic cholecystectomy is the gold standard procedure for gall stone diseases. Out of many complications one of the most important complications of laparoscopic cholecystectomy is bile duct injury particularly in difficult cases.  Difficulties arise during creation of pneumoperitonium, releasing adhesion, identifying anatomy, anatomical variations and during extraction of gall bladder.Methods: A prospective study was carried out at VSS institute of Medical Science and Research, Burla, Sambalpur, a tertiary referral centre and a teaching hospital in the western Odisha. One hundred patients with symptomatic cholelithiasis were taken up for the study after due clearance from the institutional ethical committee. They were evaluated for risk factors such as-age of the patient, sex of the patient, previous abdominal surgery, number of previous attacks, total WBC count, gall bladder wall thickness and pericholecystic collection on ultrasonography.Results: Previous abdominal surgery, duration since acute attack, number of previous attacks, ultrasonography findings of increased wall thickness, stone impaction at neck and pericholecystic collection, increased total WBC count are associated with difficult laparoscopic cholecystectomy.Conclusions: The predictors for difficult cholecystectomy will make the surgeon extra cautious during the procedure so as to minimize the complications.

scholarly journals Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy

2020 ◽  
Vol 42 (3) ◽  
pp. 71-75
Author(s):  
Prem R Sigdel ◽  
Nirajan Subedi ◽  
Suman Phuyal ◽  
Ashik Pokharel ◽  
Bikal Ghimire ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Previous Abdominal Surgery ◽  
Gall Bladder Wall ◽  
History Of ◽  
Impacted Stone

Introduction Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system. MethodsA total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone. ResultsAmong 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%. ConclusionThe factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4 mm and impacted stone are the preoperative predictors of difficult LC.

scholarly journals Laparoscopic cholecystectomy: Conversion rate and complcation

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.

scholarly journals Factors determining conversion of laparoscopic to open cholecystectomy

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 Calot’s 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 Calot’s 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

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

2020 ◽  
Vol 61 (11) ◽  
pp. 1452-1462
Author(s):  
Young Rock Jang ◽  
Su Joa Ahn ◽  
Seung Joon Choi ◽  
Ki Hyun Lee ◽  
Yeon Ho Park ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Prothrombin Time ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Acute Calculous Cholecystitis ◽  
Prolonged Prothrombin Time ◽  
Ct Findings ◽  
History Of ◽  
Calculous Cholecystitis

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.

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 Laparoscopic Redo Ileocolic Resection for Crohn’s Disease in Patients with Previous Multiple Laparotomies

2018 ◽  
Vol 108 (1) ◽  
pp. 42-48 ◽  
Author(s):  
V. Celentano ◽  
F. Sagias ◽  
K. G. Flashman ◽  
J. Conti ◽  
J. Khan
Keyword(s):  
Crohn’S Disease ◽  
Laparoscopic Surgery ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Conversion Rate ◽  
Operating Time ◽  
Ileocolic Resection ◽  
Short Term ◽  
Previous Abdominal Surgery ◽  
History Of

Purposes: Over 80% of patients with primary ileocolic Crohn’s disease have a surgical resection within 10 years of diagnosis, and 40%–50% of them need further surgery within 15 years. Laparoscopic surgery can be challenging due to a thickened mesentery and the potential for fistulas, abscesses, and phlegmons. Aim of this study is to analyze the short-term outcomes of laparoscopic redo ileocolic resections for Crohn’s disease in patients with previous multiple laparotomies. Methods: All patients undergoing laparoscopic surgery for ileocolic Crohn’s disease from March 2006 to February 2017 were prospectively evaluated. Short term outcomes of laparoscopic ileocolic resection were compared between patients with previous multiple major surgeries and recurrent Crohn’s disease, and patients undergoing surgery for the first presentation of Crohn’s disease and no history of previous surgery. Conversion rate and 30-day morbidity were the primary outcomes. Reoperations, readmissions, operating time and length of stay were the secondary outcomes. Results: 29 patients with recurrent Crohn’s disease and previous multiple laparotomies were included: the number of laparotomies these patients previously underwent was 2 in 19 cases (65.5%), 3 in 9 (31%), and 4 in 1 (3.5%). In total, 90 patients with no history of any previous abdominal surgery, who underwent laparoscopic ileocecal resection for Crohn’s disease, represented the control group. No differences were found in morbidity and conversion rate. Operating time was longer in patients with history of previous abdominal surgery. Conclusion: Laparoscopic redo ileocolic resection for Crohn’s disease is feasible and safe in patients with previous multiple laparotomies at the expense of longer operating time.

scholarly journals Gall Bladder Wall Thickness as a Predictor for Laparoscopic Cholecystectomy Difficulties in Gadarif, Eastern Sudan

2021 ◽  
Vol 2 (3) ◽  
pp. 158-163
Author(s):  
Sami E. E. Salah ◽  
Hawa Yahia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wall Thickness ◽  
Operative Time ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Bladder Wall Thickness ◽  
Conversion To Open Cholecystectomy ◽  
Gall Bladder Wall ◽  
History Of

Background: Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Multiple studies have identified factors that are predictive of surgical difficulties including preoperative ultra-sonographic findings. Objective: To determine the effectiveness of sonographic measurement of gall bladder wall thickness as a predictive factor for laparoscopic cholecystectomy difficulties in Gadarif Teaching Hospital, Sudan. Patients and methods: This are a prospective, observational, analytical cross-sectional hospital-based study in which all patients who underwent laparoscopic cholecystectomy for gall stones disease and had a pre-operative sonographic measurement for GBWT in GTH in the year 2019 were included. Results: 110 cases were studied. The male to female ratio was 0.2: 1, the mean age was 35±3.8 years. Past history of the acute attack reported in 54 (48.2%) of the patients, history of ERCP was reported in 2 (1.8%) and the majority of patients 71 (64.5%) has no associated medical condition. Abdominal examination was normal in 69 (62.7%) of the patients, 35 (31.8%) patients showed positive Murphy's sign or other signs. Gall bladder thickening, as a predictor of difficulty, was normal of ≤ 3 mm in 69 (62.7%), mild (4-5 mm) in 34 (30.9%), moderate (6-7 mm) in 5 (4.5%), and severe > 7 in 2 (1.8%) of the patients. A significant association was found between GBWT and: duration of symptoms, the number of attacks, operative time and hospital stay, postoperative complication, and conversion to open cholecystectomy. Operative time was found to be associated with the experience of the operator (P-value < 0.05). Conclusion: Pre-operative sonographic increasing gall bladder wall thickness is associated with difficult laparoscopic cholecystectomy in terms of postoperative complications, prolonged operative time, and conversion to open cholecystectomy even in expert hands.

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

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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