BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. METHODS: In this study, 1,000 laparoscopic cholecystectomies performed at Ankara Numune Hospital, Fourth Department of Surgery, from March 1992 to July 1999 were prospectively analyzed. The patients studied included 804 women (80.4%) and 196 men (19.6%) with a mean age of 43.8 years (range, 30-80 years). From the data collected, only factors available to the surgeon preoperatively were considered for analysis. These factors included age, gender, history of acute cholecystitis, jaundice or pancreatitis, previous abdominal surgery, obesity and concomitant disease, white blood cell (WBC) count, preoperative liver function tests, ultrasound findings of the gallbladder, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and suspicion of common bile duct stones. Also we analyzed the case numbers as a measure of institutional experience. RESULTS: Of the 1,000 patients in whom laparoscopic cholecystectomy was attempted, 48 (4.8%) required conversion to open surgery. The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 34). Significantly independent predictive factors for conversion were male gender, previous abdominal surgery, acute cholecystitis, thickened gallbladder wall on preoperative ultrasonography, and suspicion of common bile duct stones. CONCLUSIONS: An appreciation for the aforementioned predictors of conversion will allow appropriate planning by the patient, the institution, and the surgeon.
BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. METHODS: In this study, 1,000 laparoscopic cholecystectomies performed at Ankara Numune Hospital, Fourth Department of Surgery, from March 1992 to July 1999 were prospectively analyzed. The patients studied included 804 women (80.4%) and 196 men (19.6%) with a mean age of 43.8 years (range, 30-80 years). From the data collected, only factors available to the surgeon preoperatively were considered for analysis. These factors included age, gender, history of acute cholecystitis, jaundice or pancreatitis, previous abdominal surgery, obesity and concomitant disease, white blood cell (WBC) count, preoperative liver function tests, ultrasound findings of the gallbladder, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and suspicion of common bile duct stones. Also we analyzed the case numbers as a measure of institutional experience. RESULTS: Of the 1,000 patients in whom laparoscopic cholecystectomy was attempted, 48 (4.8%) required conversion to open surgery. The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 34). Significantly independent predictive factors for conversion were male gender, previous abdominal surgery, acute cholecystitis, thickened gallbladder wall on preoperative ultrasonography, and suspicion of common bile duct stones. CONCLUSIONS: An appreciation for the aforementioned predictors of conversion will allow appropriate planning by the patient, the institution, and the surgeon.
Authors: J S Barkun; A N Barkun; J S Sampalis; G Fried; B Taylor; M J Wexler; C A Goresky; J L Meakins Journal: Lancet Date: 1992-11-07 Impact factor: 79.321
Authors: J H Peters; W Krailadsiri; R Incarbone; C G Bremner; E Froes; A P Ireland; P Crookes; A E Ortega; G A Anthone; S A Stain Journal: Am J Surg Date: 1994-12 Impact factor: 2.565
Authors: Shankar R Raman; Dovid Moradi; Bassem M Samaan; Umar S Chaudhry; Kamal Nagpal; John Morgan Cosgrove; Daniel T Farkas Journal: Surg Endosc Date: 2012-04-27 Impact factor: 4.584
Authors: Sidharth Sharma; Raymond Huang; Shirley Hui; Michael C Smith; Paul J Chung; Alexander Schwartzman; Gainosuke Sugiyama Journal: J Robot Surg Date: 2017-11-27
Authors: Yuichi Yamashita; Tadahiro Takada; Yoshifumi Kawarada; Yuji Nimura; Masahiko Hirota; Fumihiko Miura; Toshihiko Mayumi; Masahiro Yoshida; Steven Strasberg; Henry A Pitt; Eduardo de Santibanes; Jacques Belghiti; Markus W Büchler; Dirk J Gouma; Sheung-Tat Fan; Serafin C Hilvano; Joseph W Y Lau; Sun-Whe Kim; Giulio Belli; John A Windsor; Kui-Hin Liau; Vibul Sachakul Journal: J Hepatobiliary Pancreat Surg Date: 2007-01-30