Conversion Of Laparoscopic Cholecystectomy Research Articles

Use of 10-Point Operative Scoring System (G10 Score) in Predicting Conversion of Laparoscopic Cholecystectomy to Open

Introduction: Laparoscopic cholecystectomy is the most common minimally invasive surgery performed at Kathmandu Medical College Teaching Hospital (KMCTH), Nepal. This study aims to externally validate the 10-point gallbladder operative scoring system (G10 score) in predicting conversion of Laparoscopic Cholecystectomy (LC) to Open Cholecystectomy (OC), an assessment of surgical difficulty.

Intraoperative scoring system for grading severity of cholecystitis at laparoscopic cholecystectomy

Background: Various studies had been carried out to evaluate the risk of preoperative conversion in laparoscopic cholecystectomy. However, there was no grading or scoring of operative findings during surgery at present, making it difficult to compare the publications citing outcomes, including the conversion to open surgery. Sugrue in 2015 devised a scoring system based upon the intraoperative findings in Laparoscopic cholecystectomy. Aim of the study was to grade the severity of cholecystitis during laparoscopic cholecystectomy using intraoperative scoring system, to evaluate the spectrum of cholecystitis in cases of laparoscopic cholecystectomy in a tertiary center using the grades of intraoperative scores and to validate the scoring system devised by Michael Sugrue.Methods: This prospective cross sectional observatory study of 200 patients admitted for laparoscopic cholecystectomy was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months. All patients directly planned for open cholecystectomy and carcinoma gall bladder were excluded from the study. Patients were subjected to the intra operative grading system for cholecystitis severity as devised by Micheal Sugrue and the grades were classified with a score of <2 - mild; 2 to 4 -moderate, 5– 7- severe and 8 to 10 – extreme.Results: The operative grading system showed a positive correlation with the severity of cholecystitis.Conclusions: Use of this intra-operative scoring system will help us to provide a trigger for a prompt early conversion to avoid intra-operative complications associated with difficult laparoscopic cholecystectomy.

Failure of Laparoscopic Cholecystectomy Preoperative Factors as Predictors

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for gall stone disease. Few cases of acute calculous cholecystitis require conversion to open procedure which can increase the morbidity and financial burden to patient. Hence, through this study we are trying decide regarding the parameters which would help to assess the patient preoperatively and predict the outcome of laparoscopic cholecystectomy. Aims and Objectives: To assess the preoperative parameters to predict conversion of laparoscopic cholecystectomy to open cholecystectomy in patients with acute calculous cholecystitis. Materials and Methods: A prospective study was conducted at a tertiary care hospital. Study was conducted after obtaining ethical committee clearance and informed consent from patients. 100 patients were included in the study. Results: 100 patients of acute calculous cholecystitis were taken for laparoscopic cholecystectomy of which 80 patients successfully completed the procedure and remaining 20 patients had to undergo conversion to open procedure. Conclusion: Male gender, older age, patients with higher pain (VAS) score, raised TLC, raised total bilirubin, raised serum ALP are associated with failure of laparoscopic cholecystectomy. Keywords: Acute calculous cholecystitis; Cholecystectomy; Laparoscopic cholecystectomy; Failure of laparoscopy; Conversion to open cholecystectomy.

Conversion of laparoscopic cholecystectomy to open cholecystectomy in a single center

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversions to open cholecystectomy are still inevitable in certain cases. Knowledge about the rate and underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion of our LC series. This study included 320 consecutive laparoscopic cholecystectomies from January 2017 to December 2019 at Community Based Medical College Hospital Bangladesh, Mymensingh. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 15 (4.6%) patients. Out of 15 cases, the highest number of patients 10(66.6%) were in age group 50 to 59 years with a mean age of 60.1 years and standard deviation (SD) of 9.8 years. Of them 9 (60%) were male. The most common reasons for conversion of them were severe adhesions at calot's triangle 6 (40%) and acutely inflamed gallbladder 5 (33.3%), bleeding 2 (13%). No surgical procedures are complication free. The most common complication was superficial wound infection 8(2.5%). Delayed complications seen in our series is port site incisional hernia 2 (0.62%). Male gender, age older than 60 years, previous upper abdominal surgery, diabetes, and severity of inflammation were all significantly correlated with an increased conversion rate to laparotomy. LC is the preferred method even in difficult cases. This study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery.
 CBMJ 2020 July: Vol. 09 No. 02 P: 14-18

Utility of pre-operative abdominal ultrasound to predict conversion to open cholecystectomy

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy.Methods: Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

A PROSPECTIVE STUDY OF THE INCIDENCE OF CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN 100 PATIENTS

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. Conversion to an open procedure is necessary in 5–10% of patients. The aim of work: The present study was to illustrate theincidence of conversion of laparoscopic cholecystectomy to open cholecystectomy & to validate the efficacy of “CLOC” (Conversion from Laparoscopic to open cholecystectomy) risk scoring system on the patients included in the study.Patients and methods: The present observational prospective study was conducted in EL-Demerdash Teaching Hospital (January 2019- January 2020). The study included (100) symptomatic cholelithiasis patients. Patients were divided into two groups, firstly those who completed laparoscopic cholecystectomy and secondly those who were converted into open cholecystectomy. Preoperative variables included patient demographics, indications for surgery, ASA grade, admission type, ultrasound findings and preoperative endoscopic retrograde cholangiopancreatography (ERCP). Validation of the “CLOC” scoring system was applied to all patients. Operative data were gathered prospectively, and the difficulty of theprocedure was graded using the Nassar scale (grades 1–4). Results: (24%) of patients recorded difficult total score; opensurgery was conducted in (5%). There was statistically significant relation between CLOC risk scoring level and age (p 7 and conversions in the’ low risk >6 easy’ group below. (p=0.042); highly statistically significant increase of mean in difficult group compared to essay group (p < 0.001). Thedifficult group complications rate was higher than the easy group (75% versus 10.5%); gallbladder rupture was mostly reported in (37.5% and 2.6%) of difficult group and easy group cases, respectively. Receiver operating characteristics (ROC) curve sensitivity was 92%; specificity was 98.7%. Age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty. Conclusion: The present study could conclude that parametersas older age, male gender, cholecystitis, ASA, thick wall GB, preoperative ERCP are predictors for difficult LC. Meanwhile these factors are predictors for conversion to open cholecystectomy. CLOC” risk score may be the most helpful tool in stratifying risks.

Study of factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy

Now Laparoscopic Cholecystectomy is considered the treatment of choice for cholelithiasis. It has advantages over traditional open cholecystectomy in terms of minimal post-operative pain, shorter hospital stay, early recovery and better cosmesis. With increase in experience and skill selection criteria has become more liberal. All patients presenting with cholelithiasis without choledocholithiasis; and with no contraindication for general anesthesia were included in the study. Medical records of all patients who underwent LC were reviewed. Data recorded included demographic information, past medical history, indication for operation, duration of operation, reason for conversion and post-operative complications. Out of 200 patients studied 26 patients were had history of previous abdominal surgery. 3 out of 26 patients got converted to open surgery. The conversion rates among patients with previous abdominal surgery were found to be slightly higher (11.57%) compared to patients with no h/o abdominal surgeries (7.47%).

Pre-Operative and Intra-Operative Factors for Conversion of Laparoscopic Cholecystectomy to Open Choleystectomy

Pre-Operative and Intra-Operative Factors for Conversion of Laparoscopic Cholecystectomy to Open Choleystectomy

Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates

BackgroundOpen conversion rates during laparoscopic cholecystectomy vary depending on many factors. Surgeon experience and operative difficulty influence the decision to convert on the grounds of patient safety but occasionally due to technical factors. We aim to evaluate the difficulties leading to conversion, the strategies used to minimise this event and how subspecialisation influenced conversion rates over time.MethodsProspectively collected data from 5738 laparoscopic cholecystectomies performed by a single surgeon over 28 years was analysed. Routine intraoperative cholangiography and common bile duct exploration when indicated are utilised. Patients undergoing conversion, fundus first dissection or subtotal cholecystectomy were identified and the causes and outcomes compared to those in the literature.Results28 patients underwent conversion to open cholecystectomy (0.49%). Morbidity was relatively high (33%). 16 of the 28 patients (57%) had undergone bile duct exploration. The most common causes of conversion in our series were dense adhesions (9/28, 32%) and impacted bile duct stones (7/28, 25%). 173 patients underwent fundus first cholecystectomy (FFC) (3%) and 6 subtotal cholecystectomy (0.1%). Morbidity was 17.3% for the FFC and no complications were encountered in the subtotal cholecystectomy patients. These salvage techniques have reduced our conversion rate from a potential 3.5% to 0.49%.ConclusionAlthough open conversion should not be seen as a failure, it carries a high morbidity and should only be performed when other strategies have failed. Subspecialisation and a high emergency case volume together with FFC and subtotal cholecystectomy as salvage strategies can reduce conversion and its morbidity in difficult cholecystectomies.

Predictive factors of conversion in laparoscopic cholecystectomy for acute calculous cholecystitis

Purpose: Identify the predictive factors for conversion and to evaluate conversion’s impact on postoperative morbidity and mortality. Method: A retrospective study in the surgical department at Mongi Slim Hospital. We enrolled 300 patients who underwent LC for ACC between January 2015 and December 2018. Patients were divided into two groups: “Laparoscopy” for the 282 successful Laparoscopic cholecystectomies (LC) and “Conversion” for the 18 Convertions to open (CTO). A descriptive analysis of preoperative, intraoperative and postoperative data was performed, followed by a bivariate and a multivariate analysis comparing the two groups. The significance level was set at 0.05. Results: The conversion rate was 6%. The sex-ratio was 0.47. The median age was 50 years with interquartile range of 38-62 years. Bivariate analysis identified the following factors: male gender (p=0.001), age over 57 years (p=0.002), right upper quadrant tenderness (p=0.009), right upper quadrant guarding (p=0.006), leukocytosis ≥ 18000 cells /mL (p=0.002), leukopenia (<0.001), serum creatinine level > 20 mg/L (p=0.045), ultrasonographic findings like laminated gallbladder wall (p=0.033), pericholecystic abscess (p=0.045), liver abscess (p<0.001), intra-abdominal effusion (p=0.001), ACC grade II (p=0.009) and intraoperative findings like pericholecystic adhesions (p<0.001), gangrenous ACC (p=0.001), pericholecystic abscess (p=0.005), localized peritonitis (p=0.028), pediculitis (p=0.006), difficulties in identifying anatomical structures (p=0.014) and bile duct injuries (p<0.001). Multivariate analysis determined as predictive factors: male gender (OR=3.715; 95% CI [1.101-12.541]; p=0.03) and age over 57 years (OR=1.038; 95% CI [1-1.077]; p=0.04). There were no differences between the two groups in terms of postoperative morbidity and mortality. However, CTO was associated with a prolonged length of stay (p=0.02). Conclusion: The predictive factors of CTO are not modifiable. Their identification may help conduct a better communication with the patient and optimize the planning of the procedure.

Open conversion of laparoscopic cholecystectomy at Al-Sadder teaching hospital, a descriptive study

Background: Laparoscopic cholecystoctomy (LC) is getting popularity in developing countries especially in Iraq. Conversion is also common. This study intends to evaluate the causes of conversion from LC to open procedure and to establish the safety and efficacy of the procedure.Method: This is descriptive case series conducted in general surgical department at Al-sadder teaching hospital in Mayssan city from January 2014 - December 2015. Patient of more than 20 years of age presented with symptomatic gall stones where included in the study. Patient with jaundice dilated common bile duct where excluded.Result: A total of 300 patient where included. 262 patient (87.3%where female and 38 patient (12.6% where male). Twenty one patient (7% where converted to open cholecystoctomy (OC). The most common cause of conversion was dense adhesiones followed by obscure anatomy at Calots triangle. Other common causes were bleeding bile leakage. Adjacent visceral injury and instrument failure.

English

BACKGROUND Laparoscopic surgery is a kind of minimal access surgery that obviates various complications which are encountered during open method, but the outcome of procedure varies according to condition of the patient. Knowledge of these factors may be used for the preoperative counselling of the patients regarding the successful outcome of the surgery as well as to herald the risk of conversion before undertaking patients. We wanted to evaluate the various preoperative factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.c METHODS A total of 100 patients of both sexes, from all age groups and socio-economic status was included in the study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was done for each included patient and score was given according to their signs and symptoms. Patients were categorised subsequently into mild (group 1 &amp; 2), moderate (group 3 &amp; 4) and severe (group 5) difficulty as per scoring method. RESULTS The mean age was 46.21 ± 13.36, ranging between 20 years to 80 years (95 % CI 43.56 to 48.86) with 89 females and 11 males. Among the converted group, 3 (18.75 %) participants were &gt; 60 years of age and 2 (2.38 %) participants were of age &lt; 60 years. According to patient's expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as mild, moderate and severe. A total of 81 patients were categorised as mild, 17 as moderate and 2 as severe. Conversion rate is 0 % in mild difficulty group, 17.64 % in moderate difficulty group and 100 % in severe difficulty group. CONCLUSIONS Difficulty and conversion risk may be predicted accurately by using the scoring system. Surging scores indicated marked increase in difficulty levels intraoperatively and thus affects the conversion rates. Thus, it can be concluded that the scoring system accurately assessed the conversion rates of laparoscopic cholecystectomy preoperatively to open surgery. Higher scores indicated increase in difficulty level. KEYWORDS Laparoscopic Cholecystectomy, Open Cholecystectomy, Determinants

A PROSPECTIVE STUDY OF LAPAROSCOPIC CHOLECYSTECTOMY WITH PARTICULAR REFERENCE TO CONVERSION RATE

Background: Laparoscopic Cholecystectomy is established as the primary procedure for the vast majority of patients with benign gall bladder disease .1st laparoscopic cholecystectomy record in medical literature was performed in March 1987 by Phillip Mouret, in France and in 1992 accepted as new gold standard procedure across world despite of few complications.&#x0D; Aims and Objectives: To determine the causes of conversion of laparoscopic cholecystectomy to open cholecystectomy.&#x0D; Material and methods: From September 2018 to September 2019, total 85 patients were diagnosed as cholelithiasis admitted in respective unit postings of SVBP hospital Meerut and 53 cases selected for study of laparoscopic cholecystectomy. Workup of patients done with proper history, clinical examination, blood investigations and ultrasonography abdomen.&#x0D; Observations and Results: We performed laparoscopic cholecystectomy in 53 cases with male: female ratio of 1:4.9.Conversion rate was 7.5% .Most common cause of conversion was frozen calot’s with adhesions ,several other factors aid in conversion like age more than 45 years, male gender and acute phase of cholecystitis.&#x0D; Conclusion: In our study, we found that laparoscopic cholecystectomy when performed in properly selected patients is very much effective in treatment of symptomatic gall stone disease in term of less complication, less duration of operation and anaesthesia related complication ,cost effectiveness ,early return on work and daily routine activity .Thus laparoscopic cholecystectomy is gold standard procedure for gall stone disease despite of few complications and unavoidable conversion.&#x0D; Keywords: Cccl, BMI

Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy.

Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous, a surgeon may be forced to change from laparoscopy to an open procedure. Data from the literature shows that 2 to 15% of laparoscopic cholecystectomies are converted to open surgery during surgery for various reasons. The aim of this study was to identify the risk factors for the conversion of laparoscopic cholecystectomy to open surgery. A retrospective analysis of medical records and operation protocols was performed. The study group consisted of 263 patients who were converted into open surgery during laparoscopic surgery, and 264 randomly selected patients in the control group. Conversion risk factors were assessed using logistic regression analysis that modeled the probability of a certain event as a function of independent factors. Statistically significant factors in the regression model with all explanatory variables were age, emergency treatment, acute cholecystitis, peritoneal adhesions, chronic cholecystitis, and inflammatory infiltration. The use of predictive risk assessments or nomograms can be the most helpful tool for risk stratification in a clinical scenario. With such predictive tools, clinicians can optimize care based on the known risk factors for the conversion, and patients can be better informed about the risks of their surgery.

Prophylaxis of infection in region of the surgical intervention performance in laparoscopic cholecystectomy

Objective. To estimate the efficacy of prophylactic method for regional infection while performance of laparoscopic cholecystectomy, using simultaneous application of container for removal of the specimen and a two-ring wound protector of the wound. In accordance to the literature data, the infection rate in laparoscopic cholecystectomy conduction constitutes 2.4 - 9.6%.&#x0D; Materials and methods. The work was based on experience of performance of 759 laparoscopic cholecystectomies during the period of 2015 - 2018 yrs. There were performed 679 operations with the second class of microbial contamination, 17 - with the third one and 6 - with the fourth. In 21 patients the conversion into laparotomy was applied. The patients with third and fourth classes of microbial contamination of wounds were divided into two groups: the first - 61 patients, in whom a container was used for the specimen removal, and the second - 19 patients, in whom the method of combined application of container and the wound protector was applied for removal of the specimen.&#x0D; Results. Infection of region of the surgical intervention performance in laparoscopic cholecystectomy was revealed in 41 (5.40%) of 759 patients.In surgical interventions In surgical interventions, referring to second class of microbial contamination , the infection rate in the surgical intervention region have constituted 2,5%, while referring to the third class - 11.76%, and the fourth class - 34.92%. Conversion in laparoscopic cholecystectomy is accompanied with high rate of the wound infection - 38.09%.&#x0D; Conclusion. Application of the method of combined usage of container for removal of preparation and a two-ring protector of the wound in the third and the fourth classes of the wounds while performance of laparoscopic cholecystectomy have permitted to lower the infection rate in region of the surgical intervention performance from 37.70 to 5.26%.

Factors affecting conversion rates in laparoscopic cholecystectomy: a single surgeon study

Background: There is need for conversion in laparoscopic cholecystectomy (LC) in some special situation to open cholecystectomy (OC) in order to minimize intraoperative and post-operative complications. The risk factors may be patient related, the gallbladder’s pathology and the surgeon. Most studies with regards finding the risk factors for conversion in LC involved multiple surgeons which is one of the factors. Our study is prospective study where in all cholecystectomy were done by the single surgeon so as to find out other risk factors for conversion.Methods: This was a prospective study conducted between January 2017 to 2020, where in a total 152 patients posted for LC and 27 got converted to OC. The factors analyzed were the age and sex of the patient, elective or emergency surgery, acute or chronic cholecystitis, comorbid conditions, previous abdominal surgery, post endoscopic retrograde cholangiopancreatography, intra operative adhesions, intraoperative complication like bile duct injury, bleeding from cystic artery or gall bladder bed, bile leak.Results: Out of 152 patient 27 (17.8%) got converted to open cholecystectomy. Mean age was 48.86 with lowest 15 and highest age operated was 83 years, among them 63 (41.4%) were male and 89 (56.8%) were female. Fibrosis at Calot’s triangle, intraoperative adhesions, cirrhosis of liver and age older than 60 years, were all significantly correlated with an increased conversion rate to laparotomy.Conclusions: The risk factors may help to predict the difficulty of the procedure. This would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.

Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

Background: Preoperative prediction of a difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for intraoperative risk and the risk of conversion to open Cholecystectomy. Aim of study: Evaluation the impact of gall bladder wall thickness, on the outcome of laparoscopic cholecystectomy and conversion rate to open cholecystectomy assessed by sonography preoperative and postoperative measurement of gall bladder wall thickness by histopathology. Patients and Methods: A prospective study conducted in the surgical unit, Department of surgery, Baghdad Teaching Hospital between November 2010 and November 2011. Abdominal Sonography performed in 110 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic finding in operative room, and postoperatively, the gall bladder specimens were sent for histopathological measurement of wall thickness. Results: Out of 110 patients with cholecystolithiasis on sonography, we encountered easy laparoscopic cholecystectomy in 80 patients (72.7%), difficult laparoscopic cholecystectomy in 24 (21.8%) and the procedure was converted to open cholecystectomy in six patients (5.5%). The difference between Sonographic and histological measurement was within 1 mm in 102 patients (92.7%), and the other 8 patients was with 1.5 mm (7.3%) with sensitivity of (100%), specificity of (83.3%) and accuracy of (97%). Conclusion: An accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gall bladder surgery to provide information for the selection of the most appropriate approach and avoid intraoperative difficulties and surprises. On sonography gall bladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.

Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.

Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy.

Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters-including demographics, clinical history, laboratory data, and CT findings-were analyzed. Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81-1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.