Risk factors in laparoscopic cholecystectomy: A multivariate analysis

Kanakala, Venkatesh; Borowski, David W; Pellen, Michael; Dronamraju, Shridhar S.; Woodcock, Sean; Seymour, Keith; Attwood, S. E. A.; Horgan, Liam

doi:10.1016/j.ijsu.2011.02.003

Cited by 72 publications

(71 citation statements)

References 41 publications

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“…The mean operative time in our study came in agreement with those in others of same interest. The mean operative time ranges between 60-110 minutes with maximum values of 250-280 in those studies [1,3,4,8].…”

Section: Discussionmentioning

confidence: 92%

“…It may also be useful for explaining the various risks of laparoscopic and open procedures [1]. Although laparoscopic cholecystectomy has generally a low incidence of morbidity and mortality and of conversion rate to open surgery, its outcome is particularly affected by the presence and severity of inflammation, advancing patient's age, male sex and greater body mass index [3]. 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 [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Although laparoscopic cholecystectomy has generally a low incidence of morbidity and mortality and of conversion rate to open surgery, its outcome is particularly affected by the presence and severity of inflammation, advancing patient's age, male sex and greater body mass index [3]. 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 [3,4]. Laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) for combined choledochocystolithiasis is more difficult with prolonged procedure than in uncomplicated gallstone disease with a longer post-operative hospital stay [5].…”

Section: Introductionmentioning

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: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Saber¹

2015

J Surg Surgical Res

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“…An increasing ASA score has been shown in multiple studies to be an independent risk factor for CTO [25,27,28,52,62,66]. Patients with ASA score of 3 have 2.5 times odds of CTO (OR = 2.5; 95% CI: 1.3-4.6) than those with ASA score of 1 (P = 0.004) [66].…”

Section: Risk Factors and Predictivementioning

confidence: 96%

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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Background: Laparoscopic cholecystectomy is the preferred surgical operation for symptomatic gallstone disease. Conversion of laparoscopic cholecystectomy to open surgery is used to prevent intra-abdominal organ injury, for open common bile duct exploration and to repair intra-abdominal organ injury. Objective:The objective of this chapter is to review risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery, and surgical quality outcome measures. Methods:A narrative literature review using Pubmed, Medline, Cochrane library databases and Google search engine is described.Results: From the literature review, patient-and surgeon-related risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery were identified. Patient-dependent risk factors included preoperative and intraoperative variables. Current conversion of laparoscopic cholecystectomy to open surgery predictive models use only patient-dependent risk factors and were not tested on an independent sample of patients. Surgical quality outcome measures incorporate an association between conversion and intra-abdominal organ injury that demonstrates that conversion was used as an emergency strategy to repair injuries rather than a safety measure. Conclusion:Conversion of laparoscopic cholecystectomy to open surgery risk stratification based on patient-and surgeon-dependent variables may allow a better management of the patient to keep conversion at low rates and to maintain benefits of minimally invasive surgery.

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“…El diagnóstico de colelitiasis mediante imagen ecográfica es bastante efectivo (18), mientras que el diagnóstico de colecistitis aguda tiene criterios ecográficos establecidos, como: grosor de la pared vesicular igual o mayor de 4 mm, presencia de edema de la pared vesicular, litiasis intravesicular proyectada en el cuello, tamaño superior a 100 x 60 mm, líquido perivesicular, colédoco dilatado y bilis de estasis, lo que demuestra que es muy dependiente del operador (13,18,19). Sin embargo, cabe resaltar que en la investigación realizada no se encontró relación de la imagen ecográfica con la conversión de CL por falta de datos en los reportes imagenológicos.…”

Section: Discussionunclassified

Factores asociados con la conversión de la colecistectomía laparoscópica a colecistectomía abierta

et al. 2017

Rev. Colomb. Gastroenterol.

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ResumenIntroducción: la colecistitis aguda es una inflamación de la pared vesicular. El tratamiento para esta patología es netamente quirúrgico, y la colecistectomía laparoscópica es el procedimiento de elección. Esta puede sufrir conversión intraoperatoria debido a las complicaciones propias de la intervención, los factores del paciente o los asociados con el cirujano. Objetivo: el objetivo del estudio es establecer la frecuencia y la asociación de conversiones en colecistectomía laparoscópica, basándonos en los exámenes de laboratorio hematológicos y la ecografía abdominal, así como en los factores sociodemográficos. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal, observacional y retrospectivo, durante el período comprendido entre el 1 de enero y el 3 de noviembre de 2015. Se revisaron historias clínicas con diagnóstico de patología vesicular benigna de pacientes sometidos a procedimiento quirúrgico vesicular. Resultados: al 35,5% de los pacientes se les realizó una colecistectomía laparoscópica (CL), en la que fue necesario convertir a cirugía convencional al 42,8% de los pacientes. La mayoría de los pacientes intervenidos fueron mujeres (72,8%), aunque la conversión predominó en el sexo masculino. El diagnóstico preoperatorio más frecuente fue la colelitiasis (98,3%). La edad mayor de 50 años presentó un odds ratio de 0,55, mientras que la leucocitosis presentó un odds ratio de 0,40; ambas variables fueron estadísticamente significativas (p ≤0,05). Conclusiones: se determinó que una edad mayor de 50 años y/o un valor de leucocitos mayor de 10 000 mm 3 son factores de riesgo para que una colecistectomía laparoscópica falle; además, deben tenerse en cuenta los factores propios del cirujano. Palabras claveColecistectomía, colecistectomía laparoscópica, leucocitos, conversión a cirugía abierta, complicaciones. AbstractAcute cholecystitis is an inflammation of the vesicular wall whose treatment is purely surgical: a laparoscopic cholecystectomy is the procedure of choice. This can be converted intraoperatively due to complications of the intervention, patient factors or factors associated with the surgeon. The aim of this study was to establish the frequency and the association of conversions of laparoscopic cholecystectomies based on hematological laboratory tests and abdominal ultrasound as well as sociodemographic factors. Materials and Methods: This is a descriptive, cross-sectional, observational and retrospective study that was carried out from January 1 to November 3, 2015. Clinical histories of patients who had been with diagnosed with benign vesicular pathologies who underwent vesicular surgical procedures were reviewed. Results: Of the cases reviewed, 35.5% patients underwent laparoscopic cholecystectomies, and of these cases 42.8% of the procedures were converted to conventional surgery. The majority of the patients were women (72.8%), but conversions were most frequent among men. The most frequent preoperative diagnosis was cholelithiasis (98.3%). Age greater than 50 yea...

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Risk factors in laparoscopic cholecystectomy: A multivariate analysis

Abstract: Adverse outcome from LC is particularly associated with male gender, but also the patient's co-morbidity, complexity and urgency of surgery. Risk-adjusted outcome analysis is desirable to ensure an informed consent process.

Cited by 72 publications

References 41 publications

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Factores asociados con la conversión de la colecistectomía laparoscópica a colecistectomía abierta

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