BackgroundThe purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified.MethodsA total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used.ResultsLaparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications.ConclusionsAdvanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0111-4) contains supplementary material, which is available to authorized users.

No abstract

Background This study investigated how annual caseloads and the surgeon's previous experience influence the outcome in laparoscopic cholecystectomy (LCC) for acute cholecystitis.Methods Eight-hundred-ninety-two patients treated in Helsinki University Hospital in 2013-2016 were retrospectively analyzed. Surgeons were compared regarding volume -over five LCCs for acute cholecystitis a year vs. five or fewer LCCs a year, and experience -attendings vs. residents. ResultsHigh-volume surgeons (n=14) operated faster than low-volume surgeons (n=62) (91 min vs. 108 min, p. <0.001). Examining only procedures with an attending present, high-volume attendings (n=7) converted less (14.9% vs. 32.0%, p<0.001) and operated faster (95 min vs. 110 min, p<0.001) compared with low-volume attendings (n=41). The results of residents did not significantly differ from the results of attendings. ConclusionAttending surgeons, performing more than five LCCs for acute cholecystitis a year, have shorter operative times and lower conversion rates.

Background: The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons. Methods: Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study. Results: The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P<0.001), but not in emergency LCCs (18.4% vs. 15.0%, P=0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P=0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged. Conclusions: Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.