Risk factors for the conversion of laparoscopic to open cholecystectomy

Abstract

Background: Gall stones is one of the most common diseases in man. Laparoscopic cholecystectomy is the preferred procedure, mainly due to lower morbidity and mortality, thus returning to the normal activity sooner, lesser number of hospital days and lesser pain post-surgery. However, around 2-15% of the patients need to convert from laparoscopic to open surgery due to different reasons.Methods: 357 patients who came in for laparoscopic cholecystectomy were included into the study. Details such as age, height, weight, BMI, mode of surgery i.e. emergency or elective, physical and clinical examination including Ultrasound, lab results, previous history of surgery and other co morbidities were noted.Results: Out of the 357 patients, 31(8.7%) were converted to open cholecystectomies, of which, 61.3% females and 38.7% males. 58% in the open cholecystectomy group were above 60 years. 67.7% of the patients who converted to open surgery had a BMI of over 25, while it was 39.6% in case of laparoscopic surgery. 74.2% among the patients who had undergone conversion to the open surgery had pain in the right hypochondrium, 67.7% had increased WBC levels.Conclusions: Increased age, obesity, tenderness in the RHC, increased WBC levels, acute cholecystitis are the predisposing factors for the conversion of laparoscopic cholecystectomy to open cystectomy.

Can we predict difficult laparoscopic cholecystectomy preoperatively? A comprehensive study

“…Increasing age probably because of multiple number of attacks of cholecystitis might be a risk factor for difficult cholecystectomy. 6 In our study we found that 60% of patients above 50 years had difficult cholecystectomy (p-0.007) which correlates the study by Paidipelly et al and Randhava et al 2,6 In present study sex was not a statistically significant factor for predicting difficult cholecystectomy (p-0.217). It is consistent with observations of Schrenk et al 7 In our study, it was observed that BMI>27.5 was highly predictive factor for conversion to open cholecystectomy and was significantly associated with difficult cholecystectomy which was supported by data published by Randhawa et al, Gabriel et al 2,8 Number of hospitalization due to episodes of acute cholecystitis which were managed conservatively had a correlation with the difficulty level of cholecystectomy as it may lead to increased gall bladder wall thickness and cause scarring and fibrosis of gall bladder.…”

“…4 points were given each to history of previous hospitalization. Each patient was categorised as easy (score 0-5), difficult (6)(7)(8)(9)(10), very difficult (11)(12)(13)(14)(15) and compared with intra op scoring.…”