Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Hu, Alan; Menon, Ramesh; Gunnarsson, Ronny; Costa, Alan de

doi:10.1016/j.amjsurg.2017.07.029

Cited by 93 publications

(124 citation statements)

References 53 publications

(130 reference statements)

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“…Stanisic et al reported significantly higher difficulty during LC in diabetics while Raman et al and Ibrahim et al too found diabetes mellitus to be an important risk factor. 12,7 Author found significant correlation of rising BMI with increasing duration of surgery with the highest mean of 64.38 min in those with BMI >30kg/m 2 and lowest mean of 52.50 min in those with BMI <20kg/m conversion of 7.69% in their patients having BMI >30kg/m 2 was also significantly higher than in the remaining patients. 8 out of 19 studies reviewed by Hu et al concluded that high BMI is an important risk factor for conversion.…”

Section: Discussionmentioning

confidence: 93%

“…8 16 out of 30 studies reviewed by Hu et al found that older age, more than 60 years or 65 years, was an important risk factor and patients >65 years had three to five-fold chance of conversion to OC. 7 Philip Rothman et al in their meta-analysis concluded that quality of evidence for age as a risk factor for conversion was low. 9 Kanakala et al found significantly higher cardiorespiratory complications and conversion to OC amongst older patients in univariate analysis, but age became nonsignificant when other factors were adjusted for in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Hu et al found male gender to be a significant risk factor in 17 out of 30 studies reviewed by them, with studies by Lipman et al and Sanabria et al showing a four-fold higher risk in male. 7 Meta-analysis by Philip Rothman et al found that quality of evidence of male gender as a risk factor for conversion was low. 9 Vivek et al found that male sex was associated with difficult Calot's triangle dissection and increased gallbladder adhesions.…”

Section: Discussionmentioning

confidence: 99%

“…Rate of conversion from LC to OC has been variously described and ranges from 1% to 15% in literature and it is known that difficult cholecystectomies increase perioperative time and costs, complication rates, length of hospital stay and hospital costs. 7 Complications include bile duct injury, bile leak, significant bleeding, iatrogenic injuries to adjacent viscera and even death. It is, therefore, of paramount importance to identify the likely factors that predispose a patient to have a difficult LC.…”

Section: Introductionmentioning

confidence: 99%

“…7 This study was done to independently find out the possible preoperative (clinical, laboratory and ultrasound) factors in patients with gallstone disease that predispose them to have difficult LC based on the time taken, difficulty assessment by operating surgeon and conversion to OC.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative predictors of a difficult laparoscopic cholecystectomy

Kulkarni

Kumar²

2018

Int Surg J

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Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative predictors of a difficult laparoscopic cholecystectomy

Kulkarni

Kumar²

2018

Int Surg J

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Acute Cholecystitis

Gallaher

Charles

2022

JAMA

212

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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Ursodeoxycholic acid for the prevention of gallstone and subsequent cholecystectomy following gastric surgery: A systematic review and meta‐analysis

Choi

Lee

Cho

et al. 2021

J Hepato Biliary Pancreat

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Background/Purpose: Patients who undergo gastric surgery are prone to form postsurgical gallstones. Debates still exist about the need for prevention and the selection of preventive methods. No studies had been reported comparing the efficacy of prophylactic ursodeoxycholic acid (UDCA) and prophylactic cholecystectomy (PC) for lowering postsurgical gallstone formation and subsequent cholecystectomy (SC) in patients who have undergone gastric surgery. Methods: We did a systematic review to identify studies from PUBMED, EMBASE, and the Cochrane database through 30 June 2020. We conducted direct and indirect comparisons of each prophylaxis using conventional and network meta-analysis.Studies with patients who have no history of cholecystectomy and who have not had preoperative gallstone were included. Results: The excellent preventive effects of PC and UDCA were demonstrated for gallstone formation (odds ratio [OR] 0.05, [95% CI 0.01, 0.22] and 0.20, [95% CI 0.16, 0.24], respectively) and the need for SC (OR 0.10, [95% CI 0.02, 0.57] and OR 0.22, [95% CI 0.14, 0.35], respectively) than control group. The UDCA group showed a tendency to generate more gallstones (OR 3.74, [95% CI 0.88, 15.82]) and a greater need for SC (OR 2.19,) than did the PC group without statistical significance. Conclusions: Prophylaxis for gallstone formation may be needed for patients who undergo gastric surgery to reduce troublesome morbidities. Prophylactic UDCA seems to be a reasonable preventive method for postsurgical gallstone formation to ensure clinical benefit while reducing the burden of subsequent cholecystectomy for the patient as compared to a PC.

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Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Cited by 93 publications

References 53 publications

Preoperative predictors of a difficult laparoscopic cholecystectomy

Preoperative predictors of a difficult laparoscopic cholecystectomy

Acute Cholecystitis

Ursodeoxycholic acid for the prevention of gallstone and subsequent cholecystectomy following gastric surgery: A systematic review and meta‐analysis

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