Risk Predictive Factors to Convert Laparoscopic Cholecystectomy into Other Procedures

Eldo E Frezza*

Received: February 11, 2019;   Published: February 20, 2019

DOI: 10.32474/CTGH.2018.01.000128

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Abstract

Laparoscopic cholecystectomy (LC) is nowadays the procedure of choice for cholecystitis. The intraoperative finding can make this procedure quite tricky such as dense adhesions at calot’s triangle, fibrotic and contracted gallbladder, acutely inflamed or gangrenous gallbladder, cholcystoenteric fistula, etc. There are also risk factors which make laparoscopic surgery difficult like old age, male sex, obesity, previous abdominal surgery, thickened gallbladder wall, distended gallbladder, pericholecystic fluid collection, impacted stone, etc.

Methods: This is a one cohort retrospective review of patients admitted to the hospital with acute cholecystitis who during LC were converted to intraoperative cholecystostomy tube placement (CCT) or to open cholecystectomy (OC). Preoperative risk factors to predict difficult cholecystectomy were evaluated.

Results: Medical records were reviewed retrospectively from January 2010 through December 2016. IRB approval was obtained. LC was performed in 556 cases between 2010-2016, with 56 (10%) conversion: 39 CCT and 17 OC. The highest reason for conversion are Perioperative fluid around the gallbladder before surgery on the ultrasound (10%), preoperative thickness of the gallbladder (9%), Impacted stones (7%) are the predicting factor that have more changes to turn the LC into a different surgical approach. These three parameters are followed by Prior Hospitalization (3%) and presence of abdominal scar (5%). Essential factors to make a problematic surgery were postoperative perivasculitis (2%), obesity (8%), difficult liver mobilization (1%), acute and scleroatrophic cholecystitis (1%), “porcelain gallbladder” (2%). Causes of bleeding during our operation were: cirrhosis (2%), accidental adhesion tearing (0.5%) (Table 1).

Conclusion: Problematic LC can be diagnoses before the surgery and make the OR team ready for different surgical approach.

Keywords: Laparoscopic Cholecystectomy; Open Cholecystectomy; Cholecystostomy Tube; Difficult Cholecystectomy; Predictive Factors for Difficult Surgery.

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