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

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

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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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Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

Digestive Surgery ◽

10.1159/000445505 ◽

2016 ◽

Vol 33 (5) ◽

pp. 414-423 ◽

Cited By ~ 28

Author(s):

Josephine Philip Rothman ◽

Jakob Burcharth ◽

Hans-Christian Pommergaard ◽

Søren Viereck ◽

Jacob Rosenberg

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Laparoscopic Cholecystectomy ◽

Observational Studies ◽

Open Surgery ◽

Meta Analysis ◽

Preoperative Risk ◽

Preoperative Risk Factors

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Risk Factors for Conversion to Open Surgery in Patients Undergoing Laparoscopic Cholecystectomy

World Journal of Surgery ◽

10.1007/s00268-005-0612-x ◽

2006 ◽

Vol 30 (9) ◽

pp. 1698-1704 ◽

Cited By ~ 60

Author(s):

Salleh Ibrahim ◽

Tay Khoon Hean ◽

Lim Swee Ho ◽

T. Ravintharan ◽

Tan Ngian Chye ◽

...

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Conversion To Open Surgery

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Preoperative risk factors associated with conversion of laparoscopic to open cholecystectomy

Gastroenterology ◽

10.1016/s0016-5085(00)81980-0 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1519

Author(s):

Samer A. Kanaan ◽

Kenric M. Murayama ◽

Louis T. Merriam ◽

Lillian G. Dawes ◽

Jay B. Prystowsky ◽

...

Keyword(s):

Risk Factors ◽

Open Cholecystectomy ◽

Preoperative Risk ◽

Factors Associated ◽

Preoperative Risk Factors

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Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

BMC Surgery ◽

10.1186/s12893-021-01432-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Voraboot Taweerutchana ◽

Tharathorn Suwatthanarak ◽

Asada Methasate ◽

Thawatchai Akaraviputh ◽

Jirawat Swangsri ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Laparoscopic Appendectomy ◽

Open Surgery ◽

Open Cholecystectomy ◽

Abdominal Cavity ◽

Particle Sizes ◽

Open Approach ◽

Surgical Smoke ◽

Surgical Field

Abstract Background The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers. Methods Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared. Results Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001. Conclusions Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.

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Conversion of laparoscopic cholecystectomy to open cholecystectomy in a single center

Community Based Medical Journal ◽

10.3329/cbmj.v9i2.56988 ◽

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

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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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Assesment of Risk Factors For Conversion To Open Surgery In Patients Undergoing Laparoscopic Cholecystectomy

IOSR Journal of Dental and Medical Sciences ◽

10.9790/0853-1510021418 ◽

2016 ◽

Vol 15 (10) ◽

pp. 14-18

Author(s):

Chaudhary Sanchit ◽

Sharma Maneesh ◽

Wig JD ◽

Gupta NM ◽

Mahajan Amit

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Conversion To Open Surgery

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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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