Details
Category: Volume 07 Issue 10 October 2019
Hits: 1190

Title: Observational Study on Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy and Its Causes

Authors: Gopikrishna D, Sarath Chandran S, Ashwin Muthukumar R, Suresh Kumar R

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.133

Abstract

Introduction: Minimal invasive surgery has largely replaced conventional open procedures to large extent, one such case is Cholecystectomy and has become gold standard procedure of choice for Cholecystectomy and this study aims to study the rate and causes of conversion of laparoscopic Cholecystectomy into open Cholecystectomy.

Materials and Methods: A prospective non randomized observational study was done on 50 consenting patients undergoing laparoscopic Cholecystectomy in Department of General Surgery in Rajah Muthaiah Medical College, Chidambaram from June 2016 to June 2019. Patients are selected on the basis of purposive sampling method after fulfilling the inclusion and exclusion criteria.

Results: Out of 50 patients included in the study. Most common age group requiring laparoscopic Cholecystectomy is 30 to 50 years and females were found to be 80% of the targeted sample. Higher BMI and emergency laparoscopic intervention resulted in higher conservion rate of 50% and 100% respectively.

Chronic disease like diabetes in both open and Laparoscopic group was found to be 50% and hypertensive was found to be 50% and 4.2%.

In setting of acute cholecystitis and CBD calculus conversion rate was found to be 6% and 100% respectively. Incidence of complications was 50% in the converted group compared to 4.2% in Laparoscopic Cholecystectomy

Conclusion: In our study we conclude that, in acute disease conversion rate is high, presence of adhesions and inflammation intraoperatively is a key factor. The rate of conversion and bile stone spillage is proportional to the severity of disease.

Keywords: Open Cholecystectomy, Gallstones, Laparoscopic Cholecystectomy, CBD stones, Acute cholecystitis.

References

  1. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut and liver. 2012 Apr;6(2):172.
  2. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clinical epidemiology. 2014;6:99.
  3. Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. New England Journal of Medicine. 1994 Feb 10;330(6):403-8.
  4. Parekh PM, Shah NJ, Suthar PP, Patel DH, Mehta C, Tadvi HD. Bacteriological analysis of bile in cholecystectomy patients. International Journal of Research in Medical Sciences. 2017 Jan 16;3(11):3091-6.
  5. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. The American journal of surgery. 2004 Sep 1;188(3):205-11.
  6. Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Annals of surgery. 1998 Apr;227(4):461.
  7. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H. The European experience with laparoscopic cholecystectomy. The American journal of surgery. 1991 Mar 1;161(3):385-7.
  8. Csendes A, Navarrete C, Burdiles P, Yarmuch J. Treatment of common bile duct injuries during laparoscopic cholecystectomy: endoscopic and surgical management. World journal of surgery. 2001 Oct 1;25(10):1346-51.
  9. Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2010 Oct;14(4):476.
  10. Ludwig K, Bernhardt J, Steffen H, Lorenz D. Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surgical endoscopy. 2002 Jul 1;16(7):1098-104.
  11. Beal JM. Historical perspective of gall stone disease. Surg Gynecol Obstet 1984;158:81.
  12. Traverso LW.:Carl Langenbuch and the first cholecystectomy. Am J Surg. 1976 Jul;132(1):81-2.
  13. Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 1998 Oct;2(4):341.
  14. Chalkoo M, Ahanger S. The Historical Perspective, Current Advancements and Innovations in Laparoscopic Cholecystectomy. J Pak Med Stud. 2012; 2(3):86-87.
  15. Moore KL, Dalley AF, Agur AM. Clinically oriented anatomy. Lippincott Williams & Wilkins; 2013 Feb 13.
  16. Bismuth H. Surgical anatomy and anatomical surgery of the liver. world Journal of Surgery. 1982 Jan 1;6(1):3-9.
  17. Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot's triangle, and variations in cystic arterial supply. Surgical endoscopy. 2000 Feb 21;14(2):141-4.
  18. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. The American Journal of Surgery. 1966 Sep 1;112(3):337-47.
  19. Daniels BT, McGlone FB, Job H, Sawyer RB. Changing concepts of common bile duct anatomy and physiology. JAMA. 1961 Oct 28;178(4):394-7.
  20. Everson GT. Gallbladder function in gallstone disease. Gastroenterol Clin North Am 1991;20:85-110.
  21. Njeze GE. Gallstones. Nigerian Journal of Surgery. 2013;19(2):49-55.
  22. Behar J. Physiology and pathophysiology of the biliary tract: The gallbladder and sphincter of Oddi—A review. ISRN Physiology. 2013 Feb 24;2013.
  23. Afdhal NH. Diseases of the Gallbladder and Bile Ducts. In: Goldman L, Ausiello D. (eds.). Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:65-78
  24. Laparoscopic Cholecystectomy, Intraoperative Cholangiography and Common Bile Duct Exploration. In, Josef E. Fisher (ed), Mastery of Surgery Volume 1, 5th edition. Wolters Kluwer Publishers, 2007; 1116-28.
  25. Mills JC, Stappenbeck TS, Bunnett NW. Gastrointestinal disease. In: McPhee SJ, Hammer GD, eds.Pathophysiology of Disease: An Introduction to Clinical Medicine. 6th ed. New York, NY: McGraw-Hill Medical; 2010.

Corresponding Author

Gopikrishna D

Department of General Surgery, Rajah Muthiah Medical College, Chidambaram