Page 61 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Validation of CLOC Score in Predicting the Risk of

Conversion from Laparoscopic to Open Cholecystectomy

in Dr Cipto Mangunkusumo Hospital

1
2
Yarman Mazni , Agi Satria Putranto , Farisda Pujilaksono Mulyosaputro 3
AbstrAct
Introduction: Laparoscopic cholecystectomy is the gold standard for treatment of symptomatic cholelithiasis. Although relatively safe and
effective, laparoscopic cholecystectomy is a difficult procedure. The rate of conversion to open cholecystectomy is estimated to be 1–15%.
A preoperative predictive model may be helpful in determining whether open cholecystectomy is preferred over laparoscopic cholecystectomy
to prevent morbidity and mortality associated with conversion. Conversion from laparoscopic to open cholecystectomy (CLOC) score can
potentially predict the risk of conversion based on preoperative parameters. The purpose of this study is to validate the application of CLOC
score in Dr Cipto Mangunkusumo Hospital’s patient population.
Materials and methods: This was a retrospective study of patients undergoing laparoscopic cholecystectomy from January 2018 to December
2019 in Dr Cipto Mangunkusumo Hospital. Patient data were obtained from medical records. Descriptive analysis, Chi-square test, logistic
regression analysis, and score validation using receiver-operating characteristic (ROC) curve by calculating the area under curve (AUC),
sensitivity, and specificity were conducted. Based on the CLOC Score, the patients were stratified into two groups: low-risk (<6) and high-
risk (>6).
Results: There were 163 subjects with a mean age of 51.06 ± 13.3 years. The rate of conversion was 3.1% (n = 5). Most of the subjects were
40–69 years of age (111 subjects, 68.1%). Of all 163 subjects, 103 (63.2%) were female. The indications for surgery were colicky pain (symptomatic
gallstone disease) in 144 subjects (88.3%). Based on the logistic regression analysis, common bile duct dilation was found to be the only statistically
significant variable [odds ratio (OR) = 10.97; 95% confidence interval (CI): 1.72–69.95]. The AUC approached 78.8% (fair) (95% CI: 58.2–99.4%;
p = 0.029) for a cut-off value of 6.5 (sensitivity = 80.0%; specificity = 79.1%). The median duration of procedure in the low-risk group vs the
high-risk group was 120 minutes (30–330) vs 180 minutes (45–405) (p = 0.001), respectively.
Conclusion: Common bile duct dilation was the only risk factor found to be significantly associated with conversion of laparoscopic
cholecystectomy to open surgery. Other factors, such as age, sex, indication for surgery, gallbladder wall thickness, and ASA score were not
found to be statistically significant risk factors. Conversion from laparoscopic to open cholecystectomy score was considered valid and useful
in predicting the risk of conversion. A CLOC score of 7 or more was associated with a higher risk of conversion to open surgery.
Keywords: Cholecystectomy, CLOC score, Conversion, Laparoscopy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1531

IntroductIon 1–3 Department of Surgery, Division of Digestive Surgery, Faculty of
Currently, laparoscopic cholecystectomy is deemed the gold Medicine Universitas Indonesia, Dr Cipto Mangunkusumo Central
standard in the treatment of symptomatic cholelithiasis. Although General Hospital, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta,
considered to be safe and effective, laparoscopic cholecystectomy Indonesia
is a difficult surgical procedure, indicated by the relatively high rate Corresponding Author: Farisda Pujilaksono Mulyosaputro, Department
of conversion to open cholecystectomy of approximately 1–15%. of Surgery, Division of Digestive Surgery, Faculty of Medicine Universitas
Conversion to open cholecystectomy usually increases perioperative Indonesia, Dr Cipto Mangunkusumo Central General Hospital, Kota
time and complication rate in addition to overall healthcare costs. Jakarta Pusat, Daerah Khusus Ibukota Jakarta, Indonesia, Phone: +62
Open conversion is also associated with various complications, 2131930373, e-mail: farisda.dr@gmail.com
including injury to the biliary system, bile leak, hemorrhage, How to cite this article: Mazni Y, Putranto AS, Mulyosaputro FP.
reoperation, need for blood transfusion, and even death. 1–3 Validation of CLOC Score in Predicting the Risk of Conversion from
Predicting the risk of conversion from laparoscopic to open Laparoscopic to Open Cholecystectomy in Dr Cipto Mangunkusumo
cholecystectomy preoperatively is an important aspect of Hospital. World J Lap Surg 2022;15(2):157–162.
preoperative planning. With the more accurate prediction tool, Source of support: Nil
surgeons can prepare and plan the procedure better to reduce Conflict of interest: None
perioperative morbidity and mortality. Patients will also benefit
from more accurate information with regards to the procedure so
that they may make informed medical decisions better suited to appropriate initial approach whether open should be preferred
their expectations. Preoperative prediction tools can also improve over laparoscopic cholecystectomy in order to avoid morbidity and
the assessment and the decision-making in choosing for the more mortality associated with conversion. 2–4

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