Samer Al Masri1, Yaser Shaib2, Mostapha Edelbi1, Hani Tamim2, Faek Jamali1, Nicholas Batley3, Walid Faraj1,4, Ali Hallal5. 1. Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. 2. Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. 3. Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon. 4. Division of Hepatobiliary and Pancreatic Surgery, American University of Beirut Medical Center, Beirut, Lebanon. 5. Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. ah05@aub.edu.lb.
Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard surgical treatment for benign gallbladder disease. Nevertheless, conversion to open cholecystectomy (OC) is needed in some cases. The aim of this study is to calculate our institutional conversion rate and to identify the variables that are implicated in increasing the risk of conversion (LC-OC). MATERIALS AND METHODS: We carried out a retrospective study of all cases of LC performed at the American University of Beirut Medical Center between 2000 and 2015. Each (LC-OC) case was randomly matched to a laparoscopically completed case by the same consultant within the same year of practice, as the LC-OC case, in a 1:5 ratio. Forty-eight parameters were compared between the two study groups. RESULTS: Forty-eight out of 4668 LC were converted to OC over the 15-year study period; the conversion rate in our study was 1.03%. The variables that were found to be most predictive of conversion were male gender, advanced age, prior history of laparotomy, especially in the setting of prior gunshot wound, a history of restrictive or constrictive lung disease and anemia (Hb < 9 g/dl). The most common intraoperative reasons for conversion were perceived difficult anatomy or obscured view secondary to severe adhesions or significant inflammation. Patients who were in the LC-OC arm had a longer length of hospital stay. CONCLUSION: Advance age, male gender, significant comorbidities and history of prior laparotomies have a high risk of conversion. Patients with these risk factors should be counseled for the possibility of conversion to open surgery preoperatively. Further research is needed to determine whether these high risks patients should be operated on by surgeons with more extensive experience in minimal invasive surgery.
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard surgical treatment for benign gallbladder disease. Nevertheless, conversion to open cholecystectomy (OC) is needed in some cases. The aim of this study is to calculate our institutional conversion rate and to identify the variables that are implicated in increasing the risk of conversion (LC-OC). MATERIALS AND METHODS: We carried out a retrospective study of all cases of LC performed at the American University of Beirut Medical Center between 2000 and 2015. Each (LC-OC) case was randomly matched to a laparoscopically completed case by the same consultant within the same year of practice, as the LC-OC case, in a 1:5 ratio. Forty-eight parameters were compared between the two study groups. RESULTS: Forty-eight out of 4668 LC were converted to OC over the 15-year study period; the conversion rate in our study was 1.03%. The variables that were found to be most predictive of conversion were male gender, advanced age, prior history of laparotomy, especially in the setting of prior gunshot wound, a history of restrictive or constrictive lung disease and anemia (Hb < 9 g/dl). The most common intraoperative reasons for conversion were perceived difficult anatomy or obscured view secondary to severe adhesions or significant inflammation. Patients who were in the LC-OC arm had a longer length of hospital stay. CONCLUSION: Advance age, male gender, significant comorbidities and history of prior laparotomies have a high risk of conversion. Patients with these risk factors should be counseled for the possibility of conversion to open surgery preoperatively. Further research is needed to determine whether these high risks patients should be operated on by surgeons with more extensive experience in minimal invasive surgery.
Authors: Lucia Ilaria Sgaramella; Angela Gurrado; Alessandro Pasculli; Nicola de Angelis; Riccardo Memeo; Francesco Paolo Prete; Stefano Berti; Graziano Ceccarelli; Marco Rigamonti; Francesco Giuseppe Aldo Badessi; Nicola Solari; Marco Milone; Fausto Catena; Stefano Scabini; Francesco Vittore; Gennaro Perrone; Carlo de Werra; Ferdinando Cafiero; Mario Testini Journal: Surg Endosc Date: 2020-08-11 Impact factor: 4.584
Authors: Łukasz Warchałowski; Edyta Łuszczki; Anna Bartosiewicz; Katarzyna Dereń; Marta Warchałowska; Łukasz Oleksy; Artur Stolarczyk; Robert Podlasek Journal: Int J Environ Res Public Health Date: 2020-10-18 Impact factor: 3.390