Conversion of laparoscopic cholecystectomy to open cholecystectomy

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Conversion of laparoscopic cholecystectomy to open cholecystectomy

Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 10

Abstract

Background: laparoscopic cholecystectomy became the first choice of treatment for symptomatic cholelithiasis, but still we may be enforced during laparoscopic cholecystectomy to convert the operation to open cholecystectomy due to many reasons and factors which related to the patients, surgeonsand gall bladder status and quality of the facilities . Objective: We aim to reduce the percentage of laparoscopic cholecystectomyconversion by studying the causes and its percentage which impose the surgeon to convert the operation and the effect of that conversion on the operatives’ outcome regarding morbidity and mortality and to study the importance of evaluation of the patient preoperatively. Patient and method: We did a prospective study in AL-Kadhimiya teaching hospital including 700 patients came with gall bladder symptomatic diseases in the period from April 2014-November 2016, we exclude patient with cardiopulmonary diseases, gall bladder malignancy and major bleeding disorder. Information has been written including: history of present illness, jaundice, previous operation and any concomitant disease. Physical examination has been done .Lap investigation include: liver function test, WBC& complete blood picture, CXR, ultrasoundabdomen and the indication of the operation. Three-four port technique has been used .The causes and rate of the conversion and the effect on morbidity have been written,the patients have been admitted one day preop.or the day of operation & the permission for conversion of lap. Choley has been taken. We analyzed the data to find rate of conversion which was 4.51%, and the causes of conversion which included adhesion, hemorrhage, iatrogenic injury to the bile duct and other organs and other causes. Result : We followed 700 patient in our study and after excluding malignant cases we had 686 patient which distributed according to the gender : 440 female and 246 male.The rate of conversion to open choley 4.51% (31 patient)and these include 16 female and 15 male, the mean age was 50 year (range 30-70y) the conversion rate in male was 6.09% and in the female 3.8% .Of the causes for conversion which founded were :sever adhesion (18 patient) and fibrosis of Callot’s triangle (3 patient),other causes wereabnormal anatomy ,equipment failure ,iatrogenic injury :including bowel injuryin 0.3% ,vascular injury in 2% and biliary injury which was 0.3% we try to avoid its injury by using scope of 30 ,adequate identification of the structures in callot’s triangle and avoidance of excessive use of diathermy near bile duct confluence. Many factors affect theconversionrate and related to the skill of the operator as it decrease with the senior operator 2.38% and increase with the junior operator 7.89% also the state of the gall bladder as it is acute or chronic,in acute cholecystitis the conversion rate was 18.3% while in chronic cholecystitis the conversion was 1.64%.The post-operative morbidity reported in 5 cases 16.12%. Conclusion: Lapcholey can be done safely with conversion rate less than 5% in all patient groups. Many causes and factors encounter in conversion can be avoided by good training ,experience ,taking full history & full examination of the patient with proper selection of the case , good equipment .

Authors and Affiliations

Dr. Jafar Abo-Talib Mohammed Saied

Keywords

Lapcholey conversion open choley acute cholecystitis

EP ID EP239228
DOI 10.9790/0853-1610027177
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