Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Factors Affecting Conversion of Laparoscopic

Cholecystectomy to Open Surgery in a Tertiary Healthcare

Center in India

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Sunil Krishna , Poojitha Yalla , Rajgopal Shenoy 3
AbstrAct
Background: Laparoscopic cholecystectomy (LC) is the surgery of choice for patients suffering from gallstone diseases. Open cholecystectomy
these days is performed after conversion from laparoscopic surgery due to various reasons. The aim of this study was to assess the factors
responsible for conversion of LC to open surgery by identifying preoperative risk factors that could predict conversion and intraoperative
technical/surgical difficulties and complications that cause conversion.
Methods: A total of 310 patients were included in this prospective observational study conducted between November 2018 and March 2020.
Results: Out of 310 cases, 38 were converted to open surgery with a conversion rate of 12.2%. Mean age was 10 years more in the converted
group. Males had a higher chance of conversion than females (18.6 vs 7%). Conversion rate was significantly higher in patients with body mass
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index (BMI) >23 kg/m (25%), with features of acute cholecystitis, who underwent interval cholecystectomy (25.8%), who underwent endoscopic
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retrograde cholangiopancreatography (ERCP) (>40%), with total white blood cell (WBC) counts ≥10,000/mm (25.6%), with serum albumin
<3.5 g/dL (43.8%), with imaging findings of acute cholecystitis (25.6%), and with dilated common bile duct (CBD)/choledocholithiasis (33.3%).
Conversion rate when LC was performed early after ERCP was 18% and when performed after 4–6 weeks was >50%. The most common causes
for conversion were a frozen Calot’s triangle due to dense inflammatory adhesions, leading to inadequate visualization of critical structures.
Conclusion: Identifying patients with significant risk factors for conversion could minimize adverse effects of prolonged surgery by limiting
duration of trial of laparoscopic dissection. Surgical residents need to identify low-risk patients preoperatively and require proper training
before handling difficult cases.
Clinical significance: Early LC should be considered in all patients who are able to withstand surgery, as delayed surgery increases the chances
of conversion.
Registration of the study: This prospective study has been registered in the Clinical Trials Registry of India (CTRI). CTRI Registration Number
CTRI/2018/11/016338.
Keywords: Acute cholecystitis, Calot’s triangle, Complicated gallbladder, Delayed laparoscopic cholecystectomy, Endoscopic retrograde
cholangiopancreatography, Laparoscopic cholecystectomy, Open surgery.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1491

IntroductIon 1–3 Department of Surgery, Kasturba Medical College, Manipal
The first laparoscopic cholecystectomy (LC) was performed in Academy of Higher Education, Manipal, Karnataka, India
1985, and it is the current “gold standard” operation for patients Corresponding Author: Poojitha Yalla, Department of Surgery,
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with gallstone disease. The most common indications include Kasturba Medical College, Manipal Academy of Higher Education,
symptomatic gallstone disease, acute cholecystitis, and gallstone Manipal, Karnataka, India, Phone: +91 9740604983, e-mail:
pancreatitis. Absolute contraindications include an inability to poojithayalla@hotmail.com
tolerate general anesthesia, patients with severe cardiovascular How to cite this article: Krishna S, Yalla P, Shenoy R. Factors Affecting
or pulmonary disease, and patients with gallbladder (GB) cancer. Conversion of Laparoscopic Cholecystectomy to Open Surgery in a
Many conditions previously thought to be contraindications for LC Tertiary Healthcare Center in India. World J Lap Surg 2022;15(1):1–7.
are no longer considered contraindications, e.g., gangrenous GB, Source of support: Nil
empyema of the GB, obesity, pregnancy, previous upper abdominal
procedures, and cirrhosis, as there has been a tremendous Conflict of interest: None
advancement in the technique and experience of laparoscopic
surgeons.
Open cholecystectomy these days is generally performed MAterIAls And Methods
after conversion from the laparoscopic approach. Factors affecting A prospective observational study was conducted in the Department
conversion of LC to open surgery include patient- and disease- of General Surgery, Kasturba Hospital, Manipal, India. A total of 310
related factors, as well as technical difficulties. The two most patients above the age of 18 years who were planned for LC during
frequent indications for conversion currently are dense upper the study period of November 2018 till March 2020 were included.
abdominal adhesions resulting in a frozen Calot’s triangle or a Exclusion criteria were (i) gallbladder carcinoma; (ii) laparoscopy
necrotic GB wall that precludes grasping and elevation with a done, cholecystectomy not done/procedure abandoned; and (iii)
grasper. 2 other surgical procedures performed simultaneously.

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