CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY INTO OPEN CHOLECYSTECTOMY: AN EXPERIENCE IN 300 CASES
Abstract
Background: Laparoscopic cholecystectomy is getting popularity in developing countries especially in Pakistan. Conversion from laparoscopic to open cholecystectomy is also common. This study intends to evaluate the causes of conversion from laparoscopic cholecystectomy to open cholecystectomy and to establish the efficacy and safety of the procedure. Methods: This descriptive case series was conducted in the department of General Surgery at Social Security Teaching Hospital Islamabad from November 2012 to October 2015. Patients of more than 20 years of age presenting in OPD with symptomatic gallstones were included in the study. Patients with dilated CBD (>8 mm in diameter), jaundice, acute cholecystitis, mass at porta hepatis and positive hepatitis B or C virology were excluded. Results: A total of 300 patients were included in the study; 262 (87.33%) were females and 38 (12.67 %) were males. Twenty-one (7%) patients were converted to open cholecystectomy. Most common cause of conversion was dense adhesions followed by obscure anatomy at Calot’s triangle. Other common causes were bleeding, bile leakage, visceral injuries and instrument failure. In the first 100 cases, 10% patients were converted to open cholecystectomy followed by 6% in the next 100 cases. Only 5% patients were converted to open cholecystectomy in the last 100 cases. Conclusion: Most common cause of conversion from laparoscopic cholecystectomy to open cholecystectomy was dense adhesions followed by obscure anatomy at Calot’s triangle.Keywords: Laparoscopic Cholecystectomy, Complications, Laparoscopy, conversion.References
References:
Mouret P. From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg. 1991;8:124 –125.
Peters JH, Krailadsiri W, Incarbone R, Bremner CG, Froes E, Ireland AP, et al. Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg. 1994;168(6):555-9
Khan N, Siddiq G. Outcome of Laparoscopic Cholecystectomy for Gall Stones Disease in Patients With Liver Cirrhosis. J Ayub Med Coll Abbottabad. 2013;25(1-2):36-9
Geraci G, Sciume C, Pisello F, Volsi FL, Facella T, Modica G. Trocar-related abdomnal wall bleeding in 200 patients after laparoscopic cholecystectomy : personal experience. J Gastroenterol. 2006;12:7165-7.
Dalwani AG, Shaikh R, Das K, Devrajani T, Shah ZA, Shah A. Complications of Laparoscopic Cholecystectomy at Liaquat University, Jamshoro. World Applied Sciences Journal. 2013; 23 (6): 808-811,
Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR. Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg. 2002; 6: 800-5.
Mufti TS, Ahmad S, Naveed D, Akbar M, Zafar A. Laparoscopic Cholecystectomy: An Early Experience at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad. 2007;19(4):42-44
Livingstone EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecysectomy. Am J Surg. 2004; 188:205-211.
Nair RJ, Dunn DC, Fowler S, McCloy RF. Progress with cholecystectomy: improving results n England and Wales. Br J. Surg.1997; 84: 1396-8.
Ali SA, Soomro AG, Mohammad AT, Jarwar M, Siddique AJ. Experience of Laparoscopic Cholecystectomy During A Steep Learning Curve at A University Hospital. J Ayub Med Coll Abbottabad. 2012;24(1):27-29
Mohammad S, Hinduja T, Fatima S. Complications of Laparoscopic Cholecystectomy in Acute Cholecystitis. J Surg Pak. 2008;13 (2):59-61
Gholipour C, Fakhree MBA, Shalchi RA, Abbasi M. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surgery. 2009;9:13-19
Kuldip S, Ashish O. Difficult laparoscopic cholecystectomy: A large series from north India. Indian J Surg. 2006; 68(4): 205-208
Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors Influencing the Successful Completion of Laparoscopic Cholecystectomy. JSLS. 2009;13:581–586
Genc V, Sulaimanov M, Cipe G, Basceken SI, Erverdi N, Gurel M et al. What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations. Clinics Sao Paulo. 2011;66(3): 417–420.
Memon MR, Muhammad G, Arshad S, Jat MA, Bozdar AG, Shah QA. Study of Open Conversion In Laparoscopic Cholecystectomy. Gomal J Med Sci. 2011;9(1):51-54
Mattioli FP, Cagnazzo A, Razzetta F, Bianchi C, Varaldo E, Campagna A, et al. Laparoscopic cholecystectomy. An analysis of the reasons for a conversion to conventional surgery in an elective surgery department. Minerva Chir. 1999; 54: 471-6.
Iqbal P, Saddique M, Baloch TA. Factors Leading To Conversion In Laparoscopic Cholecystectomy. Pak J Surg. 2008;24(1):9-11
Sajid MT, Hussain SM, Bashir RA, Mustafa QA, Ahmed M, Halim A et al. Laparoscopic Cholecystectomy: Experience At A Tertiary Level Hospital. J Ayub Med Coll Abbottabad 2014;26(2):225-9
Le VH, Smith DE, Johnson BL. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. Am Surg. 2012;78(12):1392-5.
Nizamuddin S, Islam AU. Factors responsible for conversion of laparoscopic cholecystectomy. Pak J Surg.2009; 25(2):132-51. Mouret P. From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg 1991;8(2):124–5.
Peters JH, Krailadsiri W, Incarbone R, Bremner CG, Froes E, Ireland AP, et al. Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg 1994;168(6):555–9.
Khan N, Siddiq G. Outcome of Laparoscopic Cholecystectomy for Gall Stones Disease in Patients With Liver Cirrhosis. J Ayub Med Coll Abbottabad 2013;25(1-2):36–9.
Geraci G, Sciume C, Pisello F, Volsi FL, Facella T, Modica G. Trocar-related abdomnal wall bleeding in 200 patients after laparoscopic cholecystectomy: personal experience. Word J Gastroenterol 2006;12(44):7165–7.
Dalwani AG, Shaikh R, Das K, Devrajani T, Shah ZA, Shah A. Complications of Laparoscopic Cholecystectomy at Liaquat University, Jamshoro. World App Sci J 2013;23(6):808–11.
Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR. Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 2002;6(6):800–5.
Mufti TS, Ahmad S, Naveed D, Akbar M, Zafar A. Laparoscopic Cholecystectomy: An Early Experience at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2007;19(4):42–4.
Livingstone EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecysectomy. Am J Surg 2004;188(3):205–11.
Nair RJ, Dunn DC, Fowler S, McCloy RF. Progress with cholecystectomy: improving results in England and Wales. Br J Surg1997;84(10):1396–8.
Ali SA, Soomro AG, Mohammad AT, Jarwar M, Siddique AJ. Experience of Laparoscopic Cholecystectomy During A Steep Learning Curve at A University Hospital. J Ayub Med Coll Abbottabad 2012;24(1):27–9.
Mohammad S, Hinduja T, Fatima S. Complications of Laparoscopic Cholecystectomy in Acute Cholecystitis. J Surg Pak 2008;13(2):59–61.
Gholipour C, Fakhree MBA, Shalchi RA, Abbasi M. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surg 2009;9:13–9.
Singh K, Ohri A. Difficult laparoscopic cholecystectomy: A large series from north India. Indian J Surg 2006;68(4):205–8.
Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors Influencing the Successful Completion of Laparoscopic Cholecystectomy. JSLS 2009;13(4):581–6.
Genc V, Sulaimanov M, Cipe G, Basceken SI, Erverdi N, Gurel M, et al. What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations. Clinics (Sao Paulo) 2011;66(3):417–20.
Memon MR, Muhammad G, Arshad S, Jat MA, Bozdar AG, Shah QA. Study of Open Conversion In Laparoscopic Cholecystectomy. Gomal J Med Sci 2011;9(1):51–4.
Mattioli FP, Cagnazzo A, Razzetta F, Bianchi C, Varaldo E, Campagna A, et al. Laparoscopic cholecystectomy. An analysis of the reasons for a conversion to conventional surgery in an elective surgery department. Minerva Chir 1999;5497-8):471–6.
Iqbal PE, Saddique MO, Baloch TA. Factors Leading To Conversion In Laparoscopic Cholecystectomy. Pak J Surg 2008;24(1):9–11.
Sajid MT, Hussain SM, Bashir RA, Mustafa QA, Ahmed M, Halim A, et al. Laparoscopic Cholecystectomy: Experience At A Tertiary Level Hospital. J Ayub Med Coll Abbottabad 2014;26(2):225–9.
Le VH, Smith DE, Johnson BL. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. Am Surg 2012;78(12):1392–5.
Nizamuddin S, Islam AU. Factors responsible for conversion of laparoscopic cholecystectomy. Pak J Surg.2009; 25(2):132–5.
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