Risk Factors for Conversion during Laparoscopic Cholecystectomy: Retrospective Analysis of Ten Years' Experience at a Single Tertiary Referral Centre

Sultan, Ahmed; Nakeeb, Ayman El; Elshehawy, Talaat; Elhemmaly, Mohamed; Hanafy, Ehab El; Atef, Ehab

doi:10.1159/000347164

Cited by 22 publications

(23 citation statements)

References 42 publications

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“…In our study, extensive peritoneal adhesions were responsible for 8.62% of the overall complication rate especially operative bleeding and conversion to open surgery. Many studies of same interest reported that previous upper abdominal surgery is associated with a higher rate of adhesions, an increased risk of operative complications, a greater conversion rate, a prolonged operating time and longer stay [4,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Saber¹

2015

J Surg Surgical Res

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Introduction: Preoperative complexity estimation helps deciding whether to proceed with a minimally invasive approach, perform an open procedure or make a referral to a more experienced surgeon. Laparoscopic cholecystectomy outcome is particularly affected by the presence and severity of inflammation, advancing age, male sex and greater BMI. Objective:The aim was to trace outcome of laparoscopic cholecystectomy with difficult situation. Patients and Methods:A total of 204 patients with difficult situation cholecystitis were enrolled to this study. The triad of clinical examination, laboratory data and ultrasound study was preformed for all patients. The primary end point of the study was operative outcome and the second end point was morbidity related to surgery. Results:The operative outcome was represented as operative bleeding and conversion to open surgery while the postoperative outcome was biliary leakage and port site infection. The total score for each patient with conversion to open surgery or with postoperative biliary leakage was between 6-10 points indicating difficult surgical approach according to the scoring system. Conclusion:Preoperative prediction of risk factors of conversion or difficulty is an important point for operative planning and the high risk patients may be informed accordingly. cholecystectomy in our patients with difficult situation according to the recently published scoring system [6].

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Section: Discussionmentioning

confidence: 99%

“…Score of (0-5) indicates an easy approach while score of (6-10) indicates difficult approach and very difficult approach is observed with score of (11)(12)(13)(14)(15).…”

Section: Difficulty Scoringmentioning

confidence: 99%

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Saber¹

2015

J Surg Surgical Res

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“…Also, (Gholipour et al, 2009), in their study (Gholipour et al, 2009), which included 793 patients in 2009, introduced factors affecting the disease as leukocytosis (white blood cells more than 9,000). In addition, different researches (Jethwani et al, 2013;Sultan et al, 2013), identified leukocytosis as a risk factor for laparoscopic cholecystectomy conversion to open surgery. This finding was also emphasized in another study (Shiva, 2017), in which the researcher also cited leukocytosis as a risk factor for disease.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

Roozbahani

Shahmoradi

Mehri

et al. 2019

Int. J. Adv. Biol. Biomed. Res.

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Introduction:The aim of this study was to determine factors affecting the development of acute cholecystitis toward gangrenous cholecystitis in an Iranian society; so that, the early diagnosis could pave the way for better management of this disorder. Materials and methods: In this cross-sectional study, all patients who underwent cholecystectomy in the educational hospitals of Khorramabad from August 2013 to August 2016 were included in the study regardless of their age range. The diagnosis of acute cholecystitis in these patients was based on the presence of Murphy's sign, mass or pain or tenderness of RUQ, presence of leukocytosis, fever, and ultrasound findings of Cholelithiasis, increased gallbladder thickness, or fluid accumulation around the gallbladder. The data collected in each patient included demographic data, underlying illnesses, positive history and physical examination prior to surgery, early laboratory findings and preoperative imaging findings. Finally, patients were divided into two groups of acute Cholecystitis and Gangrenous Cholecystitis based on pathological findings after cholecystectomy. The data were finally analyzed using SPSS software. Results: 51 patients were examined during the study. Histological studies indicated the presence of microscopic evidence of acute cholecystitis in all patients, of which 19 (37.25%) had histological evidence of Gangrenous Cholecystitis. In this study, nine variables that could be effective on the prognosis of acute cholecystitis and its progression toward the Gangrenous Cholecystitis were identified. These variables included age, white blood cell count, diabetes mellitus and coronary artery disease, fluid accumulation around gallbladder, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and lipase. Finally, multivariate analysis was performed using logistic regression. It was found that the age of was effective in the development of dia betes mellitus. Also, WBC≥15k/cmm were independently effective on the prognosis of acute cholecystitis. Conclusion: In this study, it was observed that high age, diabetes mellitus and leukocytosis Mehrdad Mirzaei Roozbahani et al. Int. J. Adv. Biol. Biomed. Res. 2019, 7(3):255-262 256 | Page could lead to the development of acute cholecystitis toward Gangrenous Cholecystitis, a finding that requires more extensive studies with more sample size.

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“…Several reports have identified male gender as a risk factor for transformation (Sultan et al, 2013;Lipman M et al, 2007) the exact explanation is not fully known but it may due to the fact that men are more tolerant to pain than women or reluctant or too busy to seek medical advice (Sultan et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Difficult Laparoscopic Cholecystectomy

Alhamid¹

2019

GJHS

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Laparoscopic cholecystectomy is as much easy procedure as difficult one. Surgeon should consider every case as his first one. Intraoperative complications are common while transformation to open surgery should be always in consideration. Transformation to open cholecystectomy isn't a sign of lack of experience, rather it is a proof of surgeon cleverness and an evidence of professional competence as it could keep our patient away from life-threatening complications in difficult situations. Predictive factors for difficulty vary from male patient, repeated acute attacks, history of obstructive jaundice, presence of abnormal anatomical or pathological findings, and adhesions. The aim of this study was to assess some preoperative causes namely by history, clinical examination and, radiological data which can dependably anticipate the odds of troublesome laparoscopic Cholecystectomy or alteration to open Cholecystectomy .1005 patients experienced laparoscopic cholecystectomy 171 of them were difficult cases (10.05%). Transformation rate in our study is within the lower limits and accepted internationally. Dense fibrous adhesion and bleeding are the main causes of transformation. History of acute cholecystitis is separate hazard factor for transformation from laparoscopic to open procedure. Gender and age are also showing increasing rate of transformation. Results shown bile duct damages may evaded even with nearness of hazard factors as anatomical variations from the of biliary channels, intense cholecystitis, extreme endless fibrosis, affected stones inside Hartmann pocket, and short cystic pipe during laparoscopic cholecystectomy by careful watching and wise decision of transformation whenever surgeon feels risk of major complication in case of proceeding in laparoscopic technique. Mortality not encountered directly through the procedure or in short post-operative period but as sequel of complicated cases. Authors proposes that change of the laparoscopic cholecystectomy isn't really a disappointment of the specialist, as usually explained, yet is a lifesaving method as delineated by the results of the study. The experience of the operating surgeon assumes an essential function on this subject.

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Risk Factors for Conversion during Laparoscopic Cholecystectomy: Retrospective Analysis of Ten Years' Experience at a Single Tertiary Referral Centre

Cited by 22 publications

References 42 publications

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

Difficult Laparoscopic Cholecystectomy

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