Page 65 - World Journal of Laparoscopic Surgery

Validation of CLOC Score
The sensitivity and specificity values of CLOC score found in However, this study did have several limitations. This study
this study were considered decent for screening tool. In addition, did not have any subjects with CBD gallstones; thus, this study
the optimal cut-off value found in this study was similar to the cannot yet include CBD gallstones as a risk factor for conversion
original study, which was lower risk for conversion in patients to open cholecystectomy in RSCM. Subsequent multicenter study
with a CLOC score of ≤6 and higher risk of conversion in patients encompassing more variable indication for surgery is required.
4
with a CLOC score of >6. Thus, CLOC score may be reliably Alternatively, an isolated study identifying patients indicated for
applied as a predictive tool for conversion to open procedure cholecystectomy due to CBD gallstones might also be conducted.
in patients who will undergo laparoscopic cholecystectomy in
RSCM hospital. conclusIon
The Association between CLOC Score and Duration Conversion from laparoscopic to open cholecystectomy risk score
of Surgery is deemed valid and applicable for predicting the risk of conversion
The median duration of surgery in the conversion group in this from laparoscopic to open cholecystectomy in RSCM. A cut-off value
study was significantly different with the median duration in the of a high-risk score (>6) was associated with the rate of conversion,
control group. Patients who underwent conversion had longer and a low-risk score (≤6) was not associated with conversion. Other
median duration of surgery compared with those who did not significant risk factors were dilation of the common biliary duct
undergo conversion [270 (230–300) vs 130 (30–405) minutes]. In above normal diameter. Risk factors not found to be significantly
4
the study by Sutcliffe et al., the median duration of laparoscopic associated with conversion were age, sex, indication for surgery,
surgery was 60 minutes, while the median duration of conversion gallbladder wall thickness, and ASA classification. The median
to open surgery was 120 minutes (p < 0.001). The longer duration duration of laparoscopic cholecystectomy surgery and conversion
of laparoscopic surgery in RSCM was possibly related to its status as in RSCM was longer compared with most other studies. The finding
an academic hospital and thus procedures were more likely to be of this study suggested that the CLOC risk score may be employed
performed by inexperienced residents or fellows. Longer duration in preoperative assessment of patients planned to undergo
4
of surgery according to Sutcliffe et al. may be one factor associated cholecystectomy to predict the risk of conversion and prevent the
with increased rate of overall complications, bile leak, biliary duct mortality and morbidity risks associated with conversion. During
injury, and longer length of stay. laparoscopic cholecystectomy, procedure may also be prolonged,
In accordance with those findings, CLOC was also found to be especially in patients with high-risk CLOC score.
associated with the median length of surgery with a p = 0.001. In
the low-risk CLOC score group, the median duration of surgery was orcId
180 (45–405) minutes, which was 60 minutes longer compared with Yarman Mazni https://orcid.org/0000-0003-0375-8581
the high-risk CLOC score group, which was 120 (30–330) minutes. Agi Satria Putranto https://orcid.org/0000-0001-9667-3346
This finding supports the reasoning that care of high-risk patients Farisda Pujilaksono Mulyosaputro https://orcid.org/0000-0002-
is more complex and thus prolongs their duration of surgery. 8629-8316
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An English study by Tafazal et al. reported the difference
between mean duration of laparoscopic cholecystectomy
procedure between consultant surgeons (52.5 minutes) and AcknowledgMents
trainees (51.4 minutes); however, this difference was not found to The authors would like to thank everybody involved in this research.
be statistically significant. When adjusted and stratified for case
complexity, surgeries performed by consultant surgeons were references
5 minutes faster compared with operations by trainees. On the 1. Thami G, Singla D, Agrawal V, et al. A study of predictive factors
14
other hand, a study by Subhas et al. in Michigan, the duration in laparoscopic cholecystectomy determining conversion to
of laparoscopic cholecystectomy ranged from 3 hours to 6 hours open cholecystectomy with special reference to body mass
40 minutes. Average duration of surgery was 3 hours 37 minutes. index. J Evol Med Dent Sci 2015;4(74):12894–12898. DOI: 10.14260/
Causes of prolonged surgery were a previous history of abdominal jemds/2015/1859.
surgery and bowel adhesion, with an OR of 6.7; obesity (OR 3.1); 2. Al Masri S, Shaib Y, Edelbi M, et al. Predicting conversion from
gallstones measured >2.5 cm and educational participation of laparoscopic to open cholecystectomy: a single institution
residents during surgery were also found to increase the duration retrospective study. World J Surg 2018;42(8):2373–2382. DOI: 10.1007/
of cholecystectomy. 15,16 s00268-018-4513-1.
3. Hu ASY, Menon R, Gunnarsson R, et al. Risk factors for conversion
Study Limitations of laparoscopic cholecystectomy to open surgery - a systematic
The calculation of sample size for this study used the formula literature review of 30 studies. Am J Surg 2017;214(5):920–930. DOI:
10.1016/j.amjsurg.2017.07.029.
for single sample proportion. In that formula, no component of 4. Sutcliffe RP, Hollyman M, Hodson J, et al. Preoperative risk factors for
statistical power was calculated, although there was the component conversion from laparoscopic to open cholecystectomy: a validated
of precision or study accuracy (d). At the beginning of calculation, risk score derived from a prospective UK database of 8820 patients.
the author had set a precision value of 5%. If re-calculated with HPB 2016;18(11):922–928. DOI: 10.1016/j.hpb.2016.07.015.
such proportion number, a value of 0.03 and a sample size of 163 5. Tayeb M, Rauf F, Bakhtiar N. Safety and feasibility of laparoscopic
subjects were obtained. The sample size used in this study exceeded cholecystectomy in acute cholecystitis. J Coll Physicians Surg Pak
2018;28(10):798–800. PMID: 30266128.
the targeted minimum sample size, which was 50 subjects. The 6. Amin A, Haider MI, Aamir IS, et al. Preoperative and operative risk
statistical power of this study was 80%, and thus, the findings were factors for conversion of laparoscopic cholecystectomy to open
not considered preliminary and can be applied widely in various cholecystectomy in Pakistan. Cureus 2019;11(8):e5446. DOI: 10.7759/
populations. cureus.5446.

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