Conversion Rate in Laparoscopic Cholecystectomy: Evolution from 1993 and Current State

Abstract

The definition of difficult laparoscopic cholecystectomy (LC) is inconsistent. The aim of this study was to analyze the factors that make LC difficult to perform and determine ways to avoid conversion, based on our series. All patients who underwent LC or open cholecystectomy (OC) between January 1993 and December 2001 in our division of general surgery were the subject matter of this study. Preliminary decisions regarding LC or OC were avoided. Our experience (1993-2001) was based on 1360 consecutive elective LC procedures in 381 male and 979 female patients. The mean age of the patients at operation was 53 years (range, 17-84). The median operating time was 55 minutes (range, 35-180). The overall conversion rate was 1.8%. Indications for conversion included surgical difficulty during the laparoscopic procedure and anesthesia issues. The conversion rate has decreased to less than 1% in recent years. There were no mortalities, and the postoperative complication rates were low. The mean hospital stay of the patients was 2.6 days. In conclusion, based on our experience, we suggest limiting OC to patients with proven contraindications to LC (i.e., Mirizzi syndrome or systemic illness incompatible with pneumoperitoneum), attempting LC in all other cases, and considering cholecystostomy and delayed LC as an alternative to conversion during difficult LC.

Complications of laparoscopic cholecystectomy: an analysis of 1,695 laparoscopic operations

“…6 The major cause of intraoperative and postoperative complication was due to abnormal ductal and vascular anatomy. Similarly reported by Capizzi F et al 7 The major intra-operative complications occurred due to LCs was bile leakage from gall bladder (1.53%), other problem such as cystic duct injury (0.64%), and spillage of stone (1.3%). Bile leakage was prevented by clipping the accessory bile duct.…”

Resultados de la colecistectomía videolaparoscópica en el adulto mayor

“…7,8 . La cifra de 19% de conversión a cirugía laparotómica resulta mayor que la observada para la colecistectomía videolaparoscó-pica en la población general [9][10][11] , pero muy acorde a las publicaciones internacionales en pacientes mayores de 70 años, donde corresponde al doble o más aún que las correspondientes a pacientes no geriátricos 12,13 . Un problema a considerar especialmente en la colecistectomía videolaparoscópica, es la presencia del carcinoma oculto de la vesícula biliar.…”

“…Por otro lado, la colecistolitiasis en Chile es una patología quirúrgica de muy alta incidencia, afectando también a la población de ambos sexos, en edades iguales o mayores de 60 años [4][5][6] . Todo lo anterior, explica que la colecistectomía videolaparoscópica en el paciente adulto mayor sea frecuente hoy en día [8][9][10] . De particular interés es el hecho que en este grupo etario se incluye pacientes de mayor riesgo anestésico…”

“…Por otro lado, la colecistolitiasis en Chile es una patología quirúrgica de muy alta incidencia, afectando también a la población de ambos sexos, en edades iguales o mayores de 60 años [4][5][6] . Todo lo anterior, explica que la colecistectomía videolaparoscópica en el paciente adulto mayor sea frecuente hoy en día [8][9][10] . De particular interés es el hecho que en este grupo etario se incluye pacientes de mayor riesgo anestésico quirúrgico en función de la coexistencia habitual de patología médica de variada índole 11,12 ; además de condiciones anatómicas locales menos favorables debido a una más prolongada evolución de su patología biliar [13][14][15] .…”

Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

“…The term difficult cholecystectomy refers to multiple technical intra-operative difficulties that increases the risk of complications and significantly prolongs operation time. 8,9 It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC, which not only helps in patient counselling but also helps the surgeon to prepare better for intra-operative difficulties expected to be encountered. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.…”