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Factors Affecting Conversion of Laparoscopic Cholecystectomy to Open Surgery

Factors Affecting Conversion of Laparoscopic Cholecystectomy to Open Surgery Abstract Objective: To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery. Design: Demographic, ultrasonographic, and operative data of patients who underwent laparoscopic cholecystectomy were analyzed. Factors affecting conversion to open surgery were identified with statistical analysis. Setting: A tertiary referral center. Patients: Five hundred patients who underwent laparoscopic cholecystectomies at our institution between March 1991 and July 1994. The patients' data had been prospectively collected. Intervention: Standard laparoscopic techniques with selective preoperative endoscopic retrograde cholangiopancreatography. Main Outcome Measure: Conversion of laparoscopic cholecystectomy to open surgery for management of technical difficulties or intraoperative complications. Results: Increased risk of conversion with statistical significance was found in patients older than 65 years, obese patients, patients who underwent interval elective laparoscopic cholecystectomy for acute cholecystitis, patients with ultrasonographic findings of thickened gallbladder wall, patients seen during the early learning phase of the series, and patients whose surgery was performed by senior surgeons. Increased risk of conversion was not found with patients' sex, previous lower abdominal surgery, history of acute pancreatitis or cholangitis, impaired liver function on presentation, or emergency laparoscopic cholecystectomy for acute cholecystitis. Conclusions: Risk factors, including patient factors, presentation, preoperative ultrasonography, and surgical experience, all contributed to the possibility of conversion. Knowledge of these factors may help in arranging the operating schedule, psychological preparation for the procedure, and planning of the duration of convalescence.(Arch Surg. 1996;131:98-101) References 1. Cuschieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy . Am J Surg . 1991;161:385-387.Crossref 2. Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies . N Engl J Med . 1991;324:1073-1078.Crossref 3. Barkun JS, Barkun AN, Sampalis JS, et al. Randomised controlled trial of laparoscopic versus mini-cholecystectomy . Lancet . 1992;340:1116-1119.Crossref 4. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis . Ann Surg . 1991;213:665-677.Crossref 5. Voyles CR, Petro AB, Meena AL, Haick AJ, Koury AM. A practical approach to laparoscopic cholecystectomy . Am J Surg . 1991;161:365-370.Crossref 6. Vitale GC, Collet D, Larson GM, Cheadle WG, Miller FB, Perissat J. Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients . Am J Surg . 1991;161:396-398.Crossref 7. Airan M, Appel M, Berci G, et al. Retrospective and prospective multiinstitutional laparoscopic cholecystectomy study organized by the Society of American Gastrointestinal Endoscopic Surgeons . Surg Endosc . 1992;6:169-176.Crossref 8. Peters JH, Ellison EC, Innes JT, et al. Safety and efficacy of laparoscopic cholecystectomy: a prospective analysis of 100 initial patients . Ann Surg . 1991; 213:3-12.Crossref 9. Hutchinson CH, Traverso LW, Lee FT. Laparoscopic cholecystectomy: do preoperative factors predict the need to convert to open? Surg Endosc . 1994;8: 875-878.Crossref 10. Fried GM, Barkun JS, Sigman HH, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy . Am J Surg . 1994;167:35-41.Crossref 11. Miles RH, Carballo RE, Prinz RA, et al. Laparoscopy: the preferred method of cholecystectomy in the morbidly obese . Surgery . 1992;112:818-823. 12. Unger SW, Edelman DS, Scott JS, Unger HM. Laparoscopic treatment of acute cholecystitis . Surg Laparosc Endosc . 1991;1:14-6. 13. Wilson RG, Macintyre IMC, Nixon SJ, Saunders JH, Varma JS, King PM. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis . BMJ . 1992;305:394-396.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Factors Affecting Conversion of Laparoscopic Cholecystectomy to Open Surgery

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430130100022
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery. Design: Demographic, ultrasonographic, and operative data of patients who underwent laparoscopic cholecystectomy were analyzed. Factors affecting conversion to open surgery were identified with statistical analysis. Setting: A tertiary referral center. Patients: Five hundred patients who underwent laparoscopic cholecystectomies at our institution between March 1991 and July 1994. The patients' data had been prospectively collected. Intervention: Standard laparoscopic techniques with selective preoperative endoscopic retrograde cholangiopancreatography. Main Outcome Measure: Conversion of laparoscopic cholecystectomy to open surgery for management of technical difficulties or intraoperative complications. Results: Increased risk of conversion with statistical significance was found in patients older than 65 years, obese patients, patients who underwent interval elective laparoscopic cholecystectomy for acute cholecystitis, patients with ultrasonographic findings of thickened gallbladder wall, patients seen during the early learning phase of the series, and patients whose surgery was performed by senior surgeons. Increased risk of conversion was not found with patients' sex, previous lower abdominal surgery, history of acute pancreatitis or cholangitis, impaired liver function on presentation, or emergency laparoscopic cholecystectomy for acute cholecystitis. Conclusions: Risk factors, including patient factors, presentation, preoperative ultrasonography, and surgical experience, all contributed to the possibility of conversion. Knowledge of these factors may help in arranging the operating schedule, psychological preparation for the procedure, and planning of the duration of convalescence.(Arch Surg. 1996;131:98-101) References 1. Cuschieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy . Am J Surg . 1991;161:385-387.Crossref 2. Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies . N Engl J Med . 1991;324:1073-1078.Crossref 3. Barkun JS, Barkun AN, Sampalis JS, et al. Randomised controlled trial of laparoscopic versus mini-cholecystectomy . Lancet . 1992;340:1116-1119.Crossref 4. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis . Ann Surg . 1991;213:665-677.Crossref 5. Voyles CR, Petro AB, Meena AL, Haick AJ, Koury AM. A practical approach to laparoscopic cholecystectomy . Am J Surg . 1991;161:365-370.Crossref 6. Vitale GC, Collet D, Larson GM, Cheadle WG, Miller FB, Perissat J. Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients . Am J Surg . 1991;161:396-398.Crossref 7. Airan M, Appel M, Berci G, et al. Retrospective and prospective multiinstitutional laparoscopic cholecystectomy study organized by the Society of American Gastrointestinal Endoscopic Surgeons . Surg Endosc . 1992;6:169-176.Crossref 8. Peters JH, Ellison EC, Innes JT, et al. Safety and efficacy of laparoscopic cholecystectomy: a prospective analysis of 100 initial patients . Ann Surg . 1991; 213:3-12.Crossref 9. Hutchinson CH, Traverso LW, Lee FT. Laparoscopic cholecystectomy: do preoperative factors predict the need to convert to open? Surg Endosc . 1994;8: 875-878.Crossref 10. Fried GM, Barkun JS, Sigman HH, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy . Am J Surg . 1994;167:35-41.Crossref 11. Miles RH, Carballo RE, Prinz RA, et al. Laparoscopy: the preferred method of cholecystectomy in the morbidly obese . Surgery . 1992;112:818-823. 12. Unger SW, Edelman DS, Scott JS, Unger HM. Laparoscopic treatment of acute cholecystitis . Surg Laparosc Endosc . 1991;1:14-6. 13. Wilson RG, Macintyre IMC, Nixon SJ, Saunders JH, Varma JS, King PM. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis . BMJ . 1992;305:394-396.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1996

References