Predicting Conversion from Laparoscopic to Open Cholecystectomy: A Single Institution Retrospective Study

Masri, Saadieh; Shaib, Yaser; Edelbi, Mostapha El; Tamim, Hani; Jamali, Faek R.; Batley, Nicholas; Faraj, Walid; Hallal, Ali

doi:10.1007/s00268-018-4513-1

Cited by 35 publications

(49 citation statements)

References 53 publications

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“…The obtained results showed that the following were statistically significant: age (the chance of unplanned laparotomy increases 1.05 times every year), sex (in men the chance of an unplanned laparotomy is 2.44 times higher than in women), the occurrence of neurological diseases (the chance of an unplanned laparotomy is 5.26 times greater), and diabetes (1.9 times greater chance of unplanned laparotomy). Similar results in this respect were obtained by Masri et al [ 37 ] and Coccolini et al, drawing conclusions from a meta-analysis carried out of the subject discussed [ 49 ]. Coelho, on the other hand, in studies assessing the role of gender in the results of surgery and the outcome of laparoscopic cholecystectomy, concludes that male gender is not an independent risk factor for laparoscopic conversion and perioperative complications.…”

Section: Discussionsupporting

confidence: 87%

“…Laparoscopic cholecystectomy is currently considered as the gold standard in surgical treatment of gallbladder stones [ 37 ]. Many centers around the world use the LC more frequently than classical cholecystectomy (CC) due to low invasiveness and safety of the surgeries performed, reduction of postoperative complications, faster recovery, and significantly shorter hospital stay [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

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The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy

Warchałowski

Łuszczki

Bartosiewicz

et al. 2020

IJERPH

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Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous, a surgeon may be forced to change from laparoscopy to an open procedure. Data from the literature shows that 2 to 15% of laparoscopic cholecystectomies are converted to open surgery during surgery for various reasons. The aim of this study was to identify the risk factors for the conversion of laparoscopic cholecystectomy to open surgery. A retrospective analysis of medical records and operation protocols was performed. The study group consisted of 263 patients who were converted into open surgery during laparoscopic surgery, and 264 randomly selected patients in the control group. Conversion risk factors were assessed using logistic regression analysis that modeled the probability of a certain event as a function of independent factors. Statistically significant factors in the regression model with all explanatory variables were age, emergency treatment, acute cholecystitis, peritoneal adhesions, chronic cholecystitis, and inflammatory infiltration. The use of predictive risk assessments or nomograms can be the most helpful tool for risk stratification in a clinical scenario. With such predictive tools, clinicians can optimize care based on the known risk factors for the conversion, and patients can be better informed about the risks of their surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy

Warchałowski

Łuszczki

Bartosiewicz

et al. 2020

IJERPH

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“…However, there is a wide variation in the current literature of the conversion rate to open surgery and, in accordance with this reported experience, it ranges from 2 to 15% [54][55][56]. According to Al Masri et al [54], surgery-related indications for conversion includes extensive adhesions, significant inflammation, intraoperative difficulty of bile ducts exploration, and obfuscating bleeding. Medical comorbidities (such as pulmonary disease) have been furthermore found to be a risk factor for conversion from laparoscopic to open surgery in different series and for different laparoscopic procedures [57,58].…”

Section: Discussionmentioning

confidence: 63%

“…When the CVS cannot be safely obtained during dissection of Calot's triangle, conversion to open surgery is advocated to prevent bile duct injury [53]. However, there is a wide variation in the current literature of the conversion rate to open surgery and, in accordance with this reported experience, it ranges from 2 to 15% [54][55][56]. According to Al Masri et al [54], surgery-related indications for conversion includes extensive adhesions, significant inflammation, intraoperative difficulty of bile ducts exploration, and obfuscating bleeding.…”

Section: Discussionmentioning

confidence: 85%

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

et al. 2020

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Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures. Keywords Cholecystectomy • Critical view of safety • Laparoscopy • Bile duct injuries • Intraoperative bleeding • Laparoscopic training Laparoscopic cholecystectomy (LC) is currently and worldwide considered the gold standard for the treatment of gallbladder lithiasis. Since its introduction, in the early 1990s, this procedure has gained a remarkable consensus until becoming a routine surgical procedure. LC is characterized by a reduction in postoperative pain, hospital stay, and recovery times to normal daily activities, which translates into reduced costs for the national healthcare systems (NHS) [1]. However, this procedure comes with an increased incidence of bile duct injuries (BDI), compared to open cholecystectomy (OC): 0.3% and 0.8% vs 0.2% [2-7]. LC-related BDIs include minor injuries up to complex hilar injuries, as classified by Strasberg et al., in which the and Other Interventional Techniques

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“…Laparoscopic Cholecystectomy (LC) is among the most commonly performed procedures in general surgery [1] [2]. Compared with open cholecystectomy (OC), LC is highly preferred as it is associated with less blood loss, less pain, and confer better cosmetic outcomes [3] [4] [5] [6]. Of note, reports from many studies have indicated a reduction of mortality and wound infection rates as well as improved quality of life after LC [7] [8] [9] [10].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Nomogram for Determining Patients Requiring Prolonged Postanesthesia Care Unit Length of Stay After Laparoscopic Cholecystectomy

Cao

et al. 2020

Preprint

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Background: Laparoscopic Cholecystectomy (LC) is a common surgical procedure for managing gallbladder disease. Prolonged length of stay (LOS) in the postanesthesia care unit (PACU) may lead to overcrowding and a decline in medical resource utilization. In this work, we aimed to develop and validate a predictive nomogram for identifying patients who require prolonged PACU LOS.Methods: Data from 913 patients undergoing LC at a single institution in China between 2018 and 2019 were collected, and grouped into a training set (cases during 2018) and a test set (cases during 2019). Using the least absolute shrinkage and selection operator regression model, the optimal feature was selected, and multivariable logistic regression analysis was used to build the prolonged PACU LOS risk model. The C-index, calibration plot, and decision curve analysis were used in assessing the model calibration, discrimination, and clinical application value, respectively. For external validation, the test set data was evaluated.Results: The predictive nomogram had 8 predictor variables for prolonged PACU LOS, including age, ASA grade, active smoker, gastrointestinal disease, liver disease, and cardiovascular disease. This model displayed efficient calibration and moderate discrimination with a C-index of 0.662 (95% confidence interval, 0.603 to 0.721) for the training set, and 0.609 (95% confidence interval, 0.549 to 0.669) for the test set. Decision curve analysis demonstrated that the prolonged PACU LOS nomogram was reliable for clinical application when an intervention was decided at the possible threshold of 7%.Conclusions: We developed and validated a predictive nomogram with efficient calibration and moderate discrimination, and can be applied to identify patients most likely to be subjected to prolonged PACU LOS. This novel tool may shun overcrowding in PACU and optimize medical resource utilization.

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Predicting Conversion from Laparoscopic to Open Cholecystectomy: A Single Institution Retrospective Study

Cited by 35 publications

References 53 publications

The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy

The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Development and Validation of a Nomogram for Determining Patients Requiring Prolonged Postanesthesia Care Unit Length of Stay After Laparoscopic Cholecystectomy

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