Ghulam Shabir Shaikh, Sher Muhammad Shaikh, Yasmeen Bhatti, Rajib Ali Deenari, Imamuddin Baloch, Quratulain Soomro.
Risk factors resulting in conversion of laparascopic to open cholecystectomy.
Med Channel Jan ;16(2):302-5.
INTRODUCTION: Since its introduction in 1988, Laparoscopic cholecystectomy has rapidly evolved as the procedure of choice in treatment of symptomatic gall bladder disease. But due to interplay of multitude factors, there is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. The purpose of this study was to contribute our experience to the existing data in the literature, concerning several important aspects of laparascopic cholecystectomy. METHODS: In this study, seventy six (76) laparoscopic cholecystectomies performed at surgical unit II of a community based teaching hospital of Chandka Medical College, from January 2008 to December 2008 were Prospectively analyzed. The patients studied included 72 women (95%) and 4 men (5%) with a mean age of 45.2 years (range, 25- 75 years). A written informed consent was obtained from patients included in the study and data collected on printed Performa included age, gender, history of pain in right hypochondriac region, jaundice, previous abdominal surgery, obesity and concomitant diseases (DM, HTN,,COPD), white blood cell (WBC) count, preoperative liver function tests, ultrasound findings of the gallbladder, and suspicion of common bile duct stones. RESULTS: Of the seventy six (76) patients in whom laparoscopic cholecystectomy was attempted, 8 patients (10%) required conversion to open surgery. The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 4). Significantly independent Predictive factors for conversion were male gender, previous abdominal surgery, thickened gallbladder, empyema gallbladder, on preoperative ultrasonography. CONCLUSION: This study reviews the safety and efficacy of laparoscopic cholecystectomy, but like any other surgical procedure, there are limitations to its application to all patients. There are a number of factors which may necessitate conversion of this minimally invasive to a major procedure. If these factors like Increasing age, early diagnosis of acute cholecystitis to prevent natural progression of disease, history of previous upper abdominal surgery, aberrant anatomy, co morbidities are identified appropriately or preoperatively, unexpected conversion to major procedure, postoperative morbidity and mortality can be significantly reduced.
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