Conversion and complications of elective laparoscopic cholecystectomy in a West African population

Abstract

Background Laparoscopic cholecystectomy (LC) is increasingly adopted in Nigeria, but the procedure is limited due to the low incidence of gallstone diseases. This study aims to determine the incidence of conversion and complications following elective LC. Patients and methods Consecutive patients undergoing elective LC at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, were the participants. Patients’ preoperative characteristics including ultrasonographic findings, instances of conversions, and intraoperative and postoperative complications were documented. The influence of gallbladder wall thickness on the outcome was analyzed. Results There were 150 patients, including 124 (82.7%) women and 26 (17.3%) men aged 18–82 years (mean=45.4, SD=13.38). Indications for LC were chronic calculous cholecystitis in 101 (67.3%), 45 (30%) acute calculous cholecystitis, whereas four (2.7%) had acalculous cholecystitis. Gallbladder wall thickness was normal (≤3 mm) in 98 (65.3%), thick (4–9 mm) in 35 (23.6%), and very thick (≥10 mm) in 17 (11.3%) patients, whereas 11 patients had pericholecystic fluid collection. Gallbladder mucocele was encountered in nine (6%), empyema in six (4%), and gangrenous gallbladder in two (1.3%) cases. Ten (6.7%) procedures were converted to laparotomy including two patients with hemoglobinopathies. Postoperatively, bile leaks occurred in two patients, bleeding requiring reeploration in one, and bile duct dilatation after 4 months in one patient. Acute cholecystitis, hemoglobinopathy, and thickened gallbladder wall significantly influenced conversions and occurrence of complications in this series. Conclusion We observed a low rate of conversion and complication following LC. Acute cholecystitis and thickened gallbladder wall significantly influence the conversion of LC to open procedure in our setting.