Laparoscopic Cholecystectomy Conversion Rates Two Decades Later

Sakpal, Sujit Vijay; Bindra, Supreet Singh; Chamberlain, Ronald S.

doi:10.4293/108680810x12924466007926

Cited by 91 publications

(78 citation statements)

References 27 publications

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“…9 In present study, 21 patients' (11.47%) operations were converted due to difficulties encountered intraoperatively which is higher than the conversion rate of patients found in other reports which is 5.9%, 12 due to difficult anatomy (6.55%) 8 due to the discovery of adhesions (4.37%) and one patient's operations were converted due to common bile duct injuries (0.54%). 12 Acute inflammation around Calot's triangle makes the tissue friable and difficult to grasp. Dissection in such conditions leads to excessive bleeding.…”

Section: Discussionmentioning

confidence: 99%

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

2018

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Background: Laparoscopic cholecystectomy (LC), is a new modality of surgery late surfaced late 1980s. Compared with open cholecystectomy, LC is associated with less local pain, shorter hospitalization resulting in an early return to work, and a favourable cosmetic outcome. The aim of this study was to determine the incidence of major biliary injuries associated with LC.Methods: The patients have been admitted before operation and classical LC was done. Monopolar electrocautery was used. The insertion of postoperative intraperitoneal drain or nasogastric tube depended on the surgeons' preference and opinion. The data was evaluated according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose operations had to be converted from laparoscopic to open.Results: One hundred and eighty-three (183) patients were initially included in this study. LC was accomplished successfully in one hundred and sixty-two patients (162), twenty-one have been converted to the conventional open method due to sever adhesions or unclear anatomy and they were excluded from this study. Among those who underwent LC, 5(2.73%) had major biliary injuries, another 6 (3.28) had minor injuries and 7 (3.82%) Spillage of Gallstones to the Peritoneal cavity.Conclusions: Biliary injury is the Achilles’ heel of laparoscopic Cholecystectomy. It can have devastating effects, turning the individual into a "biliary cripple". They mainly result from anatomical anomalies and errors of human judgment and are thus preventable to some extent.

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Section: Discussionmentioning

confidence: 99%

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

2018

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“…Advanced age was evaluated as a risk factor for difficult cholecystectomy (19,20). Studies suggested that LC was safe, did not increase complication rates, shortened the time of hospitalization, and was associated with a marked improvement in the quality of life for the elderly.…”

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confidence: 99%

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

Kulen¹,

Tıhan²,

Duman³

et al. 2016

UCD

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Objective: Laparoscopic cholecystectomy has become the ''gold standard'' for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly. Material and Methods:The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared. Results:The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications. Conclusion:LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.

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“…Sakpal et al have stated that male patients >50 years of age and operated by low-volume surgeons have a higher rate of conversion. [12] In our study, obtained lower rate of conversion could be associated with all of these factors since most of our patients were female, the median age was 51 years , and all operations were performed by our experienced senior staff. In recent years, drain usage in surgery has been a commonly queried issue and it has been shown that prophylactic drain insertion adds no benefits even in complicated acute cholecystitis.…”

Section: Discussionmentioning

confidence: 96%

“…Various conversion rates have been reported in the literature, ranging from 4.9% to 29%. [12][13][14] With limited number of patients, our conversion rates were 2.1% and 3%, in chronic and acute cholecystitis, respectively. Although there were high conversion rates in some studies, recent and large reports have shown marked decrease over time.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: Prospective clinical study

Çetinkünar

Erdem

Aktimur

et al. 2014

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively. METHODS:Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947). RESULTS:Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%. CONCLUSION:Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.

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Laparoscopic Cholecystectomy Conversion Rates Two Decades Later

Abstract: Male patients greater than 50 years of age and cases performed by low-volume surgeons were found to have a higher rate of conversion to open procedures.

Cited by 91 publications

References 27 publications

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: Prospective clinical study

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