Exploring Factors Influencing the Transition from Laparoscopic to Open Cholecystectomy

Abstract

Background: Gallstones represent a prevalent gastrointestinal ailment often necessitating hospitalization. The preferred surgical approach for most patients is laparoscopic cholecystectomy. Instances where the procedure is converted to an open cholecystectomy typically result from factors such as adhesions, complex anatomy at Calot's triangle, or injury to the common bile duct [1]. This study focused on patients admitted to the surgery department to identify the factors leading to the shift from laparoscopic to open cholecystectomy within a tertiary care center. Secondary objectives encompassed assessing age, gender, and etiological factors associated with cholelithiasis. Methods: This prospective observational study involved 200 admitted patients after obtaining informed consent and ethical clearance from the Institutional Review and Research Committee (IRRC). Those diagnosed with cholelithiasis through imaging techniques like ultrasonography (USG), magnetic resonance cholangiopancreatography (MRCP), and/or endoscopic retrograde cholangiopancreatography (ERCP) were planned for laparoscopic cholecystectomy [2]. The study investigated the factors linked to the conversion of laparoscopic cholecystectomy to an open procedure. Results: Among the 200 patients included in the study, 18 required conversion to an open cholecystectomy. The primary reason for conversion was adhesions, accounting for the highest proportion at 8%. Other reasons included CBD injury (2%), bleeding of the cystic artery (2%), bowel injury (1%), and unclear anatomy (3%). Conclusion: Laparoscopic cholecystectomy is a secure and minimally invasive procedure characterized by a low conversion rate. In this study, the primary reason for conversion was the significant presence of dense adhesions in Calot's triangle, underlining its importance as a common factor leading to a shift from laparoscopic to open cholecystectomy.