Acute cholecystitis: risk factors for conversion to an open procedure

Sippey, Megan; Grzybowski, Marysia; Manwaring, Mark L.; Kasten, Kevin R.; Chapman, William H.; Pofahl, Walter E.; Pories, Walter J.; Spaniolas, Konstantinos

doi:10.1016/j.jss.2015.05.040

Cited by 58 publications

(58 citation statements)

References 23 publications

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“…6 Many studies have also reported a higher incidence of difficult LC and higher rate of conversion to OC in male patients. [7][8][9] Similar gender bias was also evident in results obtained in this study inspite of the smaller sample size considered. This may be due to the fact that males more frequently suffer from acute and chronic cholecystitis and have higher quantities of intra-abdominal and visceral adipose tissues in comparison to females.…”

Section: Discussionsupporting

confidence: 84%

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

2018

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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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Section: Discussionsupporting

confidence: 84%

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

2018

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“…In addition, the CTO group of patients had a longer mean operation time (122.1 ± 51.0 min versus 80.0 ± 42.6 min, P < 0.0001) as well as the length of hospital stay (8.6 ± 13.0 days versus 3.4 ± 6.7 days, P < 0.0001) than LC patients [18].…”

Section: Risk Factors and Predictive Models For Conversion Of Laparosmentioning

confidence: 89%

“…Main disadvantages of LC compared to the conventional OC and small-incision OC are a lack of a three-dimensional view, narrow field of laparoscopic vision, inconvenience with liver retraction, insufficient tactile sensations due to manipulation with long laparoscopic instruments and difficulties with instruments placement and manoeuvring [17][18][19].…”

Section: Laparoscopic Cholecystectomymentioning

confidence: 99%

“…Quality Outcome Measures http://dx.doi.org/10.5772/63648 serious morbidity (3.8 versus 14.9%, P < 0.0001), overall morbidity (6.0 versus 21.8%, P < 0.0001) and mortality (0.5 versus 2.3%, P < 0.0001) [18]. In addition, the CTO group of patients had a longer mean operation time (122.1 ± 51.0 min versus 80.0 ± 42.6 min, P < 0.0001) as well as the length of hospital stay (8.6 ± 13.0 days versus 3.4 ± 6.7 days, P < 0.0001) than LC patients [18].…”

Section: Risk Factors and Predictive Models For Conversion Of Laparosmentioning

confidence: 99%

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Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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Background: Laparoscopic cholecystectomy is the preferred surgical operation for symptomatic gallstone disease. Conversion of laparoscopic cholecystectomy to open surgery is used to prevent intra-abdominal organ injury, for open common bile duct exploration and to repair intra-abdominal organ injury. Objective:The objective of this chapter is to review risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery, and surgical quality outcome measures. Methods:A narrative literature review using Pubmed, Medline, Cochrane library databases and Google search engine is described.Results: From the literature review, patient-and surgeon-related risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery were identified. Patient-dependent risk factors included preoperative and intraoperative variables. Current conversion of laparoscopic cholecystectomy to open surgery predictive models use only patient-dependent risk factors and were not tested on an independent sample of patients. Surgical quality outcome measures incorporate an association between conversion and intra-abdominal organ injury that demonstrates that conversion was used as an emergency strategy to repair injuries rather than a safety measure. Conclusion:Conversion of laparoscopic cholecystectomy to open surgery risk stratification based on patient-and surgeon-dependent variables may allow a better management of the patient to keep conversion at low rates and to maintain benefits of minimally invasive surgery.

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“…Low risk patients could be identified and appropriately scheduled in an ambulatory care facility, and selected as training cases for surgical trainees, 9 whilst high risk patients should be appropriately counselled and operated by experienced surgeons. The majority of studies that have evaluated risk factors for conversion to open cholecystectomy are small retrospective series or population-based databases [1][2][3][4]6,7,[10][11][12][13][14] (Table 1). Several studies have developed risk scores, but their clinical utility is limited by retrospective data, small sample sizes and/or lack of validation.…”

Section: Introductionmentioning

confidence: 99%

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Hollyman

Hodson

Bonney

et al. 2016

HPB

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Acute cholecystitis: risk factors for conversion to an open procedure

Cited by 58 publications

References 23 publications

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

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

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

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