Analysis of factors for conversion of laparoscopic to open cholecystectomy: A prospective study of 703 patients with acute cholecystitis

Domínguez, Luis Carlos; Rivera, Aura; Bermúdez, Charles; Herrera, Wilmar Eduardo

doi:10.1016/s2173-5077(11)70038-2

Cited by 16 publications

(20 citation statements)

References 35 publications

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“…Eleven studies published between 2000 and 2015 from 10 countries were evaluated [5][6][7][8][9][10][11][12][13][14][15] (Table 1). In all there were 9,992 patients of whom 7,242 were from one large database study.…”

Section: Demographicsmentioning

confidence: 99%

“…Schafer et al [11] The anatomy of Calot's triangle was either severely distorted by the advanced inflammatory reaction or hidden by adhesions, thus making the dissection hazardous Simopoulos et al [12] Inability to define anatomy in triangle of Calot 11 times more frequent in acute cholecystitis than in elective cholecystectomy Yetkin et al [15] Inability to display anatomy safely due to severe inflammation and dense adhesions Dominguez et al [8] Severe inflammation Fuks et al [9] The two main reasons were: (a) Difficulty in dissecting the biliary pedicle due to inflammation with gangrenous acute cholecystitis and (b) Adhesions resulting from local inflammation Cwik et al [6] Impossible identification of the cystic duct. Massive inflammatory or postoperative adhesions Wevers et al [14] Inability to reach the critical view of safety due to inflammatory changes Oymaci et al [10] Difficulty identifying anatomy (inflammation, biliary or vascular anomalies); inability to define anatomy including contracted or fibrotic gallbladder and cystic duct; dense adhesions of the gallbladder to either the duodenum or the common bile duct by inflammation in acute cholecystitis.…”

Section: Study Commentsmentioning

confidence: 99%

“…CRP C-reactive protein, PC fluid pericholecystic fluid not provided. In two, the cutoff was P < 0.1 [8,13]. Only variables that were tested in two or more studies are included in the analysis shown in Figure 1.…”

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

“…Age was identified as a significant predictor of conversion on multivariate analysis in six studies [5,8,[12][13][14][15]. Both maleness and WBC count were found to be significant predictors in four of these studies [5,8,12,13]. So in all, four studies identified the three variables maleness, age, and WBC count to be predictive of conversion in multivariate analysis [5,8,12,13].…”

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

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Preoperative predictors of conversion as indicators of local inflammation in acute cholecystitis: strategies for future studies to develop quantitative predictors

Panni

Strasberg

2017

J Hepato Biliary Pancreat

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Background Observational studies have identified risk factors for conversion from laparoscopic to open cholecystectomy in acute cholecystitis. The aim of this study is to evaluate the reliability of these predictors and to identify sources of heterogeneity in the studies. Methods OVID was searched for papers published from 1995 to 2016. Studies with more than 100 patients were included. Risk factors for conversion were abstracted and categorized by statistical significance. Results Eleven studies were evaluated. Inflammation with difficulty in anatomic identification was the most common reason of conversion. Because of heterogeneity among studies a quantitative approach was not possible. Therefore, qualitative analysis using a heat map was performed along with investigation into sources of heterogeneity with the aim of creating a framework for future quantitative studies. Age, maleness, and white blood cell count were most commonly identified predictors of conversion. Sources of heterogeneity were criteria for diagnosis of acute cholecystitis, selection of patients for laparoscopic cholecystectomy, selection of variables and variations in their thresholds. Conclusions In acute cholecystitis, inflammation is the most common reason for conversion. Age, maleness and white blood cell count are common predictors of conversion. Large scale prospective studies with minimal heterogeneity are needed to establish validity of these and other predictors.

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Section: Demographicsmentioning

confidence: 99%

Section: Study Commentsmentioning

confidence: 99%

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

Section: Preoperative Indicators Of the Need For Conversionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative predictors of conversion as indicators of local inflammation in acute cholecystitis: strategies for future studies to develop quantitative predictors

Panni

Strasberg

2017

J Hepato Biliary Pancreat

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Sequential histologic evolution of gallbladder inflammation in acute cholecystitis over the first 10 days after onset of symptoms

Panni

Chatterjee

Panni

et al. 2022

J Hepato Biliary Pancreat

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Background The timing of cholecystectomy during acute cholecystitis (AC) is controversial, especially whether it is advisable to perform in patients with duration of symptoms between 3 and 10 days. The purpose of this study is to define clearly the sequential evolution of histological changes following symptoms onset to guide recommendations regarding timing of cholecystectomy. Methods We identified patients with AC (2005–2018) who had cholecystectomy within 10 days of symptom onset of a first attack of AC. Histologic features of gallbladder injury including cellular and exudative inflammatory response to injury were determined on blinded pathologic slides. Results One hundred and forty‐nine patients were divided into three groups; early—who underwent cholecystectomy 1–3 days after symptom‐onset, intermediate—4–6 days, and late—7–10 days. Key features of injury were necrosis and hemorrhage. A subgroup of patients in the early phase developed severe necrosis and hemorrhage of an extent associated with difficult cholecystectomy. Large spikes in extent of necrosis and hemorrhage occurred at 7–10 days. Major inflammatory responses to injury were eosinophilic and lymphocytic infiltration and early fibrosis. Conclusions Severe necrosis may develop rapidly and be present in the early period after symptom onset of AC. Cholecystectomy may be reasonable in some patients but by day 7–10, severe necrosis and hemorrhage may be expected to be present in most patients.

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Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial

et al. 2022

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Analysis of factors for conversion of laparoscopic to open cholecystectomy: A prospective study of 703 patients with acute cholecystitis

Cited by 16 publications

References 35 publications

Preoperative predictors of conversion as indicators of local inflammation in acute cholecystitis: strategies for future studies to develop quantitative predictors

Preoperative predictors of conversion as indicators of local inflammation in acute cholecystitis: strategies for future studies to develop quantitative predictors

Sequential histologic evolution of gallbladder inflammation in acute cholecystitis over the first 10 days after onset of symptoms

Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial

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