Factors Affecting Conversion of Laparoscopic Cholecystectomy to Open Surgery in a Tertiary Healthcare Center in India
Sunil Krishna, Poojitha Yalla, Rajgopal Shenoy
Citation Information :
Krishna S, Yalla P, Shenoy R. Factors Affecting Conversion of Laparoscopic Cholecystectomy to Open Surgery in a Tertiary Healthcare Center in India. World J Lap Surg 2022; 15 (1):1-7.
Background: Laparoscopic cholecystectomy (LC) is the surgery of choice for patients suffering from gallstone diseases. Open cholecystectomy these days is performed after conversion from laparoscopic surgery due to various reasons. The aim of this study was to assess the factors responsible for conversion of LC to open surgery by identifying preoperative risk factors that could predict conversion and intraoperative technical/surgical difficulties and complications that cause conversion.
Methods: A total of 310 patients were included in this prospective observational study conducted between November 2018 and March 2020.
Results: Out of 310 cases, 38 were converted to open surgery with a conversion rate of 12.2%. Mean age was 10 years more in the converted group. Males had a higher chance of conversion than females (18.6 vs 7%). Conversion rate was significantly higher in patients with body mass index (BMI) >23 kg/m2 (25%), with features of acute cholecystitis, who underwent interval cholecystectomy (25.8%), who underwent endoscopic retrograde cholangiopancreatography (ERCP) (>40%), with total white blood cell (WBC) counts ≥10,000/mm3 (25.6%), with serum albumin <3.5 g/dL (43.8%), with imaging findings of acute cholecystitis (25.6%), and with dilated common bile duct (CBD)/choledocholithiasis (33.3%). Conversion rate when LC was performed early after ERCP was 18% and when performed after 4–6 weeks was >50%. The most common causes for conversion were a frozen Calot's triangle due to dense inflammatory adhesions, leading to inadequate visualization of critical structures.
Conclusion: Identifying patients with significant risk factors for conversion could minimize adverse effects of prolonged surgery by limiting duration of trial of laparoscopic dissection. Surgical residents need to identify low-risk patients preoperatively and require proper training before handling difficult cases.
Clinical significance: Early LC should be considered in all patients who are able to withstand surgery, as delayed surgery increases the chances of conversion.
Registration of the study: This prospective study has been registered in the Clinical Trials Registry of India (CTRI). CTRI Registration Number CTRI/2018/11/016338.
Reynolds Jr W. The first laparoscopic cholecystectomy. JSLS 2001;5(1):89. PMID: 11304004.
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004;188(3):205–211. DOI: 10.1016/j.amjsurg.2004.06.013.
Jang YR, Ahn SJ, Choi SJ, et al. Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy. Acta Radiol 2020;61(11):1452–1462. DOI: 10.1177/0284185120906658.
Simopoulos C, Botaitis S, Polychronidis A, et al. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surgical Endoscopy and Other Interventional Tech 2005;19(7):905–909. DOI: 10.1007/s00464-004-2197-0.
Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184(3):254–258. DOI: 10.1016/s0002-9610(02)00934-0.
World Health Organization (WHO). International Association for the Study of Obesity (IASO), International Obesity Task Force (IOTF). The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000. p. 20.
Chauhan S, Masood S, Pandey A. Preoperative predictors of conversion in elective laparoscopic cholecystectomy. Saudi Surg J 2019;7(1):14. DOI: 10.4103/ssj.ssj_37_18.
Thyagarajan M, Singh B, Thangasamy A, et al. Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy. Int Surg J 2017;4(10):3354–3357. DOI: 10.18203/2349-2902.isj20174495.
Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018;25(1):73–86. DOI: 10.1002/jhbp.517.
Friis C, Rothman JP, Burcharth J, et al. Optimal timing for laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: a systematic review. Scandinavian J Surg 2018;107(2):99–106. DOI: 10.1177/1457496917748224.
De Vries A, Donkervoort SC, Van Geloven AA, et al. Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter? Surgical Endosc 2005;19(7):996–1001. DOI: 10.1007/s00464-004-2206-3.
Boerma D, Rauws EA, Keulemans YC, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet 2002;360(9335):761–765. DOI: 10.1016/S0140-6736(02)09896-3.
Ishizuka M, Shibuya N, Shimoda M, et al. Preoperative hypoalbuminemia is an independent risk factor for conversion from laparoscopic to open cholecystectomy in patients with cholecystolithiasis. Asian J Endosc Surg 2016;9(4):275–280. DOI: 10.1111/ases.12301.