Assessment of Risk Factors for Conversion from Difficult Laparoscopic to Open Cholecystectomy - A Hospital Based Prospective Study
Background: Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. It has proved to be an effective and safe procedure both in elective and emergency conditions; however, conversion to open surgery is inevitable in some cases. Hence the present study was carried out t...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Krishna Vishwa Vidyapeeth (Deemed to be University), Karad
2016-07-01
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| Series: | Journal of Krishna Institute of Medical Sciences University |
| Subjects: | |
| Online Access: | http://www.jkimsu.com/jkimsu-vol5no3/JKIMSU,%20Vol.%205,%20No.%203,%20July-Sept%202016%20Page%2084-97.pdf |
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| Summary: | Background: Laparoscopic cholecystectomy is the
gold standard in the treatment of gallstones. It has
proved to be an effective and safe procedure both in
elective and emergency conditions; however,
conversion to open surgery is inevitable in some cases.
Hence the present study was carried out to identify
various factors which can predict the difficult
laparoscopic cholecystectomy so that an early
conversion to open cholecystectomy can be
considered. Material and Methods: A prospective
st st study was conducted from 1 February 2011 to 31
January 2012 that included 63 patients of all age
groups and both sexes who were found to have
symptomatic gallstones and were scheduled for
laparoscopic cholecystectomy at Nepalgunj Medical
College and Teaching Hospital, Nepal. Age, sex, body
mass index, previous abdominal surgery and past
history of acute attack of cholecystitis of the patients
were recorded. A pre-operative ultrasound was
performed just prior to surgery, and three
ultrasonographic parameters were analyzed, namely
gall bladder wall thickness, number of stones and stone
impacted in Hartmann's pouch. Intra-operative causes
for difficult laparoscopic cholecystectomy like
adhesions in Calot's triangle and gall bladder
perforation with bile leak were also evaluated. Results:
Total number of patients in this study was 63; out of
which difficult laparoscopic cholecystectomy was
seen in 25(39.7) patients and 7(11.1) patients required
conversion to open cholecystectomy. Ultrasonography
was good at predicting difficulty in each component
with exception of gall bladder wall thickness which
was not statistically significant. Conclusion: BMI, ultrasonographic finding of presence of multiple stone
or stones impacted in Hartmann's pouch, adhesion in
Calot's triangle and gall bladder perforations are
predictors of difficult laparoscopic cholecystectomy. |
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| ISSN: | 2231-4261 2231-4261 |