Johannes Spohnholz1, Torsten Herzog1, Johanna Munding2, Orlin Belyaev1, Waldemar Uhl1, Chris Braumann1, Ansgar Michael Chromik3. 1. Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany. 2. Institute of Pathology, Ruhr-University Bochum, Bochum, Germany. 3. Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany. a.chromik@klinikum-bochum.de.
Abstract
BACKGROUND: Although laparoscopic cholecystectomy is recommended as standard treatment for acute cholecystitis, in 10-30 % a conversion to open cholecystectomy is required. Among some surgeons, this is still perceived as a "complication." The aim of our study was to define characteristics and outcome of patients with acute cholecystitis undergoing conversion cholecystectomy. METHODS: Over a 9-year period, 464 consecutive patients undergoing cholecystectomy for acute cholecystitis were analyzed for demographic, preoperative, intraoperative, histopathological, and laboratory findings and surgical outcome parameters. RESULTS: Patients with conversion cholecystectomy were characterized by younger age, lower American Society of Anesthesiologists (ASA) score, and less cardiac comorbidities compared to patients with primary open cholecystectomy. Severity of inflammation on the clinical and histopathological level was similar and comparable. Overall complication rate, mortality, and median hospital stay were significantly lower compared to those of primary open cholecystectomy group. CONCLUSIONS: There are no disadvantages for patients undergoing conversion cholecystectomy compared to primary open cholecystectomy. The outcome is influenced by general condition and comorbidities rather than by the surgical approach. Underlying fear of conversion should not avoid a laparoscopic approach in patients with acute cholecystitis.
BACKGROUND: Although laparoscopic cholecystectomy is recommended as standard treatment for acute cholecystitis, in 10-30 % a conversion to open cholecystectomy is required. Among some surgeons, this is still perceived as a "complication." The aim of our study was to define characteristics and outcome of patients with acute cholecystitis undergoing conversion cholecystectomy. METHODS: Over a 9-year period, 464 consecutive patients undergoing cholecystectomy for acute cholecystitis were analyzed for demographic, preoperative, intraoperative, histopathological, and laboratory findings and surgical outcome parameters. RESULTS:Patients with conversion cholecystectomy were characterized by younger age, lower American Society of Anesthesiologists (ASA) score, and less cardiac comorbidities compared to patients with primary open cholecystectomy. Severity of inflammation on the clinical and histopathological level was similar and comparable. Overall complication rate, mortality, and median hospital stay were significantly lower compared to those of primary open cholecystectomy group. CONCLUSIONS: There are no disadvantages for patients undergoing conversion cholecystectomy compared to primary open cholecystectomy. The outcome is influenced by general condition and comorbidities rather than by the surgical approach. Underlying fear of conversion should not avoid a laparoscopic approach in patients with acute cholecystitis.
Authors: Carsten N Gutt; Jens Encke; Jörg Köninger; Julian-Camill Harnoss; Kilian Weigand; Karl Kipfmüller; Oliver Schunter; Thorsten Götze; Markus T Golling; Markus Menges; Ernst Klar; Katharina Feilhauer; Wolfram G Zoller; Karsten Ridwelski; Sven Ackmann; Alexandra Baron; Michael R Schön; Helmut K Seitz; Dietmar Daniel; Wolfgang Stremmel; Markus W Büchler Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: A M Carbonell; A E Lincourt; K W Kercher; B D Matthews; W S Cobb; R F Sing; B T Heniford Journal: Surg Endosc Date: 2005-05-03 Impact factor: 4.584