Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects

Mannino, Maurizio; Toro, Adriana; Teodoro, Michele; Catena, Fausto; Sartelli, Massimo; Ansaloni, Luca; Catena, Fausto; Carlo, Isidoro Di

doi:10.1186/s13017-019-0227-4

Cited by 10 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The experience of surgeons has a crucial role in determining the need and justification for conversion. 20,21 In our study, it was found out by the surgical team that the operation was completed by conversion approximately in 53% of the entire partial cholecystectomy cases. In 47% of the cases, the procedure was completed as LPC.…”

Section: Complicationsmentioning

confidence: 68%

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

Kurtulus

Culcu

Degerli

2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

Objective: In laparoscopic cholecystectomy, partial cholecystectomy is usually preferred when the anatomic exploration is not enough to prevent bile duct injury and other complications. Some surgeons choose laparoscopically to perform partial cholecystectomy, whereas others convert to open surgery. In this study, we aim to discuss and compare the effectiveness of laparoscopic partial cholecystectomy (LPC) and open partial cholecystectomy (OPC). Materials and Methods: The data of 4712 patients who underwent laparoscopic cholecystectomy between 2012 and 2020 were reviewed. A total of 98 patients who had partial cholecystectomy were included in the study. Patients were examined in two groups according to whether the procedure was open or laparoscopic. The first group of patients was named the OPC group (n = 52), and the second group of patients was the LPC group (n = 46). The data of the two groups were comparatively analyzed. Results: The mean operative time and the postoperative hospital stay, respectively, were 118.2 minutes and 4.8 days in the OPC group, and 87.3 minutes and 2.55 days in the LPC group (P < .005 and P = .005). It was found that wound infection decreased by 83.1% (P = .026; odds ratio [OR] = 0.169) in the LPC group compared with the OPC group, and the probability of developing incisional hernia decreased by 81.1% (P = .014; OR = 0.189). At least one complication was observed in 17 patients in the OPC group and in 7 patients in the LPC group (P = .045). The probability of developing complications in any patient was 63% lower in the LPC group (P = .049; OR = 0.370). Conclusions: The indications that cause the surgeon to perform partial cholecystectomy are inherently open to complications, regardless of the surgical technique used. However, the laparoscopic operation has advantages such as shorter operation time, shorter postoperative hospital stay, lower risk of wound infection and incisional hernia rate, and lower complication rate than the open procedure. However, if the team performing the surgery does not have enough experience, they should never hesitate to switch to open cholecystectomy.

show abstract

Section: Complicationsmentioning

confidence: 68%

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

Kurtulus

Culcu

Degerli

2022

Journal of Laparoendoscopic & Advanced Surgical Techniques

View full text Add to dashboard Cite

show abstract

“…The present update of the WSES Guidelines on ACC clarifies that, in 2016, the reasons for conversion were used as a proxy in the absence of high-quality studies; we maintained the same approach for the current version of the guidelines [7,101,102].…”

Section: Patients Who Are Pregnantmentioning

confidence: 99%

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

et al. 2020

View full text Add to dashboard Cite

Background Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.

show abstract

“…The absence of the critical view of safety (CVS) is the most important factor for conversion to open surgery. Mandatory indicators for conversion include a complete buried gallbladder, an impacted stone and the inability to retract the gallbladder [ 42 ]. In cases of severe inflammation, the identification and the dissection of the Calot’s triangle could be difficult.…”

Section: Acute Cholecystitismentioning

confidence: 99%

Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review

Ietto

Amico

Pettinato

et al. 2021

Life

View full text Add to dashboard Cite

A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.

show abstract

Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects

Cited by 10 publications

References 20 publications

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review

Contact Info

Product

Resources

About