Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors

Goonawardena, Janindu; Gunnarsson, Ronny; Costa, Alan de

doi:10.1016/j.amjsurg.2015.04.003

Cited by 57 publications

(112 citation statements)

References 27 publications

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“…7,[20][21][22] Recently, Goonawardena et al developed a predictive nomogram from a retrospective series of 732 patients. 1 Similar variables were found to be significant predictors of conversion in this and the present report. 1 Laparoscopic cholecystectomy has been the standard approach for symptomatic gallstones for more than two decades, and is Relationship between conversion risk score and conversion rates.…”

Section: Discussionsupporting

confidence: 86%

“…1 Similar variables were found to be significant predictors of conversion in this and the present report. 1 Laparoscopic cholecystectomy has been the standard approach for symptomatic gallstones for more than two decades, and is Relationship between conversion risk score and conversion rates. Reference line is based on a binary logistic model using the combination of the two datasets, with the risk score as a covariate associated with improved recovery and lower morbidity.…”

Section: Discussionsupporting

confidence: 86%

“…Depending on the availability of local expertise and resources, consideration should be given to referring very high risk patients to a specialist unit. Several risk scores have been published previously, 1,3,8,[20][21][22] but all have failed to be incorporated into routine clinical practice. Early scores have been derived from small, retrospective series using subjective variables and included data from the learning curve of the laparoscopic era.…”

Section: Discussionmentioning

confidence: 99%

“…Conversion to an open procedure is necessary in 5-10% of patients, and is associated with increased morbidity, prolonged hospitalization and longer recovery compared to a laparoscopic approach. [1][2][3][4] Common indications for conversion include failure to demonstrate the 'critical view of safety' , 1,2,5,6 or the presence of an intraoperative complication, such as intestinal perforation, haemorrhage or bile duct injury. Several factors increase the risk of conversion to open, including age, 4 male sex, 3,7 obesity, 1,2 cholecystitis 2,3,7 and previous ERCP.…”

Section: Introductionmentioning

confidence: 99%

“…Low risk patients could be identified and appropriately scheduled in an ambulatory care facility, and selected as training cases for surgical trainees, 9 whilst high risk patients should be appropriately counselled and operated by experienced surgeons. The majority of studies that have evaluated risk factors for conversion to open cholecystectomy are small retrospective series or population-based databases [1][2][3][4]6,7,[10][11][12][13][14] (Table 1). Several studies have developed risk scores, but their clinical utility is limited by retrospective data, small sample sizes and/or lack of validation.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Hollyman

Hodson

Bonney

et al. 2016

HPB

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Hollyman

Hodson

Bonney

et al. 2016

HPB

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Acute Cholecystitis

Gallaher

Charles

2022

JAMA

213

125

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cute cholecystitis is an acute inflammatory disease of the gallbladder that is caused by gallstone obstruction of the cystic duct in approximately 90% to 95% of people diagnosed with this condition. 1 Less commonly, acalculous cholecystitis, in which acute inflammation of the gallbladder develops without gallstones, is present in approximately 5% to 10% of people diagnosed with acute cholecystitis.Gallbladder disease affects approximately 20 million individuals in the US and results in estimated direct annual costs of more than $6.3 billion, with more than 200 000 people diagnosed with acute cholecystitis each year. [2][3][4] Of the 10% to 15% of adults in the US general population with cholelithiasis, approximately 80% are asymptomatic. 5 Twenty percent of patients with gallstones will eventually develop gallstone-related complications at an incidence rate of 1% to 4% annually, with calculous acute cholecystitis as the first clinical presentation in 10% to 15% of all patients with gallstones. 6 In contrast, the etiology of acalculous acute cholecystitis, defined as an acute inflammatory disease of the gallbladder in the absence of cholelithiasis, is multifactorial. Factors associated with acalculous acute cholecystitis include critical illness, diabetes, HIV infection, atherosclerosis, and total parenteral nutrition. 7,8 Acalculous acute cholecystitis is present in approximately 5% to 10% of patients presenting with acute cholecystitis. Acalculous IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of ...

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Usefulness of preoperative drip infusion cholangiography with computed tomography for predicting surgical difficulty during laparoscopic cholecystectomy

Nakazawa

Akamatsu

Miyata

et al. 2020

J Hepato Biliary Pancreat

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BackgroundDrip infusion cholangiography with computed tomography (DIC‐CT) is a major preoperative modality used for patients undergoing laparoscopic cholecystectomy (LC).MethodsThis study included 218 patients for whom preoperative DIC‐CT images were obtained prior to undergoing LC. The association between gallbladder (GB) opacification in DIC‐CT and the operative time was assessed.ResultsThe GB opacification on the DIC‐CT images was classified as follows: Grade 0, homogeneous opacification; Grade 1, heterogeneous opacification; Grade 2, only cystic duct can be identified; and Grade 3, no opacification. Images obtained for the 218 patients showed 41 (18.8%) with Grade 0, 91 (41.7%) with Grade 1, 54 (24.8%) with Grade 2, and 32 (14.7%) with Grade 3. The operative time and intraoperative blood loss were significantly longer and larger, respectively, in cases classified as Grade 2 or 3 (GB negative) compared with cases classified as Grade 0 or 1 (GB positive). We created an LC difficulty score based on the following variables that were significant independent predictors of increased operative time: GB negativity in DIC‐CT (P = .002, 2 points), GB wall thickness (P = .002, 2 points), body mass index (P = .015, 1 point), preoperative alkaline phosphatase value (P = .018, 1 point), and preoperative C‐reactive protein value (P = .04, 1 point). The LC difficulty score (Grade A, score 0‐2; Grade B, score 3‐5; and Grade C, score 6‐7) was significantly associated with a prolonged operative time.ConclusionDrip infusion cholangiography with computed tomography is useful for predicting the surgical difficulty of LC.

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Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors

Cited by 57 publications

References 27 publications

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Acute Cholecystitis

Usefulness of preoperative drip infusion cholangiography with computed tomography for predicting surgical difficulty during laparoscopic cholecystectomy

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