Evaluation of factors leading to conversion in laparoscopic cholecystectomy
Journal Title: Medpulse International Journal of Surgery - Year 2019, Vol 9, Issue 3
Abstract
Introduction: In the modern era laparoscopic cholecystectomy is established gold standard surgery for cholecystectomy. Conversion from laparoscopic to open cholecystectomy is a step towards the safety of the patient. The knowledge of preoperative and intraoperative risk factors for conversion in laparoscopic cholecystectomy is of utmost importance to the operating surgeon. Material and Methods: This prospective study was carried out in Department of General Surgery at Dr Rajendra Prasad Government Medical College at Tanda, District Kangra, Himachal Pradesh, India. It included patients from October 2011 to March 2013 who had undergone laparoscopic cholecystectomy. Results: The overall frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy of our study was 15.33%. These conversions were significantly more in those patients where preoperative factors viz. male gender, age was more than 60 years, previous history of hospitalization for acute cholecystitis or acute pancreatitis, elevated LFTs, high T.L.C and gall bladder wall thickness more than 4 mm on ultrasonography were present. Conversions to open cholecystectomy were due to obscured anatomy as a result of dense adhesions, dense adhesions with empyema or dense adhesions with contracted gall bladder, cystic artery bleed, haemorrhage from liver, bile duct injury, anatomical anomaly, light source failure, Co2 insufflator failure and hand instrument failure. Conclusion: The identification of Preoperative and Intraoperative parameters can predict conversion and can improve preoperative patient counselling, provides for better per operative planning, optimizes operating room efficiency and helps to avoid laparoscopic-associated complications by performing an open operation when appropriate. Proper maintenance of instrument should be done to prevent the forced conversion due to machinery failure. It is vital for the surgeons and patients to appreciate that the decision to go for conversion is not failure but rather implies safe approach and sound surgical judgment. Key Words: Conversion, Intraoperative risk factors, Laparoscopic Cholecystectomy, Machinery related risk factors, Open Cholecystectomy, Preoperative risk factors.
Authors and Affiliations
Abhay Singh, Shachi . , Ramesh Bharti, Amar Verma
Keywords
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- EP ID EP526593
- DOI 10.26611/106937
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