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

Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans‐Christian; Viereck, Søren; Rosenberg, Jacob

doi:10.1159/000445505

Cited by 97 publications

(76 citation statements)

References 47 publications

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“…The results showed that male patients, age 60-65 years, sclerotic gallbladder or wall thickness (4-5 mm) and acute cholecystitis, were significant risk factors for conversion[54]. …”

Section: Complicationsmentioning

confidence: 99%

“…It has been difficult to establish the role of percutaneous gallbladder drainage because of the different existing definitions for the “high-risk patient”[42,54]. In an attempt to clarify the conflicting evidences, Yeo et al[57] 2017 in a retrospective review, studied 103 aged patients (median: 80 years), who had undergone PC procedures.…”

Section: When To Perform Cholecystostomymentioning

confidence: 99%

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Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

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Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

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“…The results showed that male patients, age 60-65 years, sclerotic gallbladder or wall thickness (4-5 mm) and acute cholecystitis, were significant risk factors for conversion[54]. …”

Section: Complicationsmentioning

confidence: 99%

Section: When To Perform Cholecystostomymentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…This high rate may have resulted in increased perioperative morbidity, as OC compared to LC for acute cholecystitis is associated with increased risk of complications (28 vs. 18%, p = 0.03) [27] . A recent meta-analysis of observational studies showed that advanced age is associated with increased risk of conversion, although no obvious explanation is given [28] . Dense adhesions due to previous episodes of complicated gallstone disease or previous abdominal surgery, or perioperative cardiopulmonary complications may be the reason [19,21] .…”

Section: Discussionmentioning

confidence: 99%

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

et al. 2017

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Background: In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis. Methods: Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged ≥70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model. Results: Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4). Conclusion: Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients.

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“…Predicting the ‘difficult’ gallbladder in patients who present with AC is problematic and has important implications for resource allocation if an immediate cholecystectomy policy is adopted. Delay beyond 72 h after onset of symptoms, radiological evidence of inflammation, age >65 years, male gender and severe AC have been shown to be risk factors for conversion from laparoscopic to an open operation …”

Section: Introductionmentioning

confidence: 99%

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

Nguyen

Dijk

Smith

et al. 2019

ANZ Journal of Surgery

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Background Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same‐admission or delayed LC. Methods Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12‐month period was conducted. Results A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post‐operative length of stay and more complications compared with those who had non‐AC diagnosis. There was no difference in outcomes between same‐admission LC or delayed LC. Conclusion TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same‐admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.

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

Cited by 97 publications

References 47 publications

Acute calculous cholecystitis: Review of current best practices

Acute calculous cholecystitis: Review of current best practices

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters

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