Top PDF Factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

Factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

Factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

Gallstones are mainly composed of cholesterol, bilirubin, and calcium salts, with small amounts of protein and other materials. In Western countries cholesterol is the main constituent of more than three quarters of gallstones, and these stones many of them are more than 80 percent cholesterol. Non-cholesterol stones are categorized as black or brown pigment stones, consisting of calcium salts of bilirubin. About 15 percent of gallstones can be seen on a plain abdominal radiograph, and pigment stones constitutes two thirds of these . Calcification which is visible only on the rim occurs usually in cholesterol stones. Cholesterol gallstones formation results when the cholesterol concentration in bile exceeds the ability of bile to hold it in solution i.e. reaches its saturation point, so that crystals form and grow as stones. The lithogenicity of bile are affected by various factors.
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A prospective comparative study on laparoscopic cholecystectomy vs open cholecystectomy

A prospective comparative study on laparoscopic cholecystectomy vs open cholecystectomy

mortality,open cholecystectomy does carry a risk of potential complications. Traditionally, the complication rate for this procedure has been reported to be in the range of 6-21%, Though this has likely decreased in the current era patients with Child-Pugh class A or B cirrhosis who are undergoing cholecystectomy for symptomatic cholelithiasis, laparoscopic cholecystectomy has decreased complication rates and increased recovery as compared with open cholecyestectomy.

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Incidence of Bile Duct Injuries in Laparoscopic Vs open Cholecystectomy: A Review of Methylene Blue Injection Technique to Prevent Bile Duct Injuries in Laparoscopic Cholecystectomy

Incidence of Bile Duct Injuries in Laparoscopic Vs open Cholecystectomy: A Review of Methylene Blue Injection Technique to Prevent Bile Duct Injuries in Laparoscopic Cholecystectomy

I Dr. P.J. GOKULAKRISHNAN solemnly declare that the dissertation titled “ INCIDENCE OF BILE DUCT INJURIES IN LAPAROSCOPIC Vs OPEN CHOLECYSTECTOMY - A REVIEW OF METHYLENE BLUE INJECTION TECHNIQUE TO PREVENT BILE DUCT INJURIES IN LAPAROSCOPIC CHOLECYSTECTOMY ” has been prepared by me. I also declare that this bonafide work or a part of this work was not submitted by me or any other for any award, degree, diploma to any other University board either in India or abroad.

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A comparitive study of open cholecystectomy versus laparoscopic cholecystectomy

A comparitive study of open cholecystectomy versus laparoscopic cholecystectomy

Introduction : Gall bladder disease is the most common curable disease in female of middle age .Laparoscopic cholecystectomy has rapidly become the choice of elective surgery for the treatment of Cholecystitis even though Open Cholecystectomy remains the main modality of surgery in many centres in India. But to become an alternative to open method, it should be safe, less morbid and it should have the possibility of early return to work better than that of open the procedure. This study compares the open

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A Prospective Study: To Formulate a Scoring System for Prediction of Conversion from Laparoscopic Cholecystectomy to open Cholecystectomy

A Prospective Study: To Formulate a Scoring System for Prediction of Conversion from Laparoscopic Cholecystectomy to open Cholecystectomy

Aim: Laparoscopic cholecystectomy (LC) has become the gold standard of treatment of gall bladder disease, but conversion to open cholecystectomy is still inevitable certain cases. The knowledge of the rate& impact of the causes for conversion could help the surgeon during preoperative assessment & inform the patients accordingly .In this study we review the causes and rate of conversion to open from laparoscopic cholecystectomy.

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Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy - an expertise-based randomised controlled trial

Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy - an expertise-based randomised controlled trial

been described earlier [10]. Primary outcomes were costs and health related quality of life, reported in the current paper, and pain. Secondary outcomes were complica- tions within 30 days, operative time, length of hospital stay, conversion rate, frequency of ambulatory surgery and readmissions within 30 days, which together with pain have been reported earlier [10]. In short, SIOC was performed via a transverse incision over the right rectus muscle and laparoscopic cholecystectomy with a four- trocar technique. If the SIOC incision exceeded 8 cm, the operation was classified as an open cholecystectomy as this was the cut-off in the Swedish registry for gall- stone surgery (GallRiks) [13]. Two hospitals participated in the trial, Umeå University Hospital and Lycksele County Hospital. The study was designed as a rando- mised pragmatic expertise-based trial [12, 14], where participating surgeons were asked to join one of two teams, performing either SIOC or LC, according to their personal preferences. Team members performed their specific method (SIOC or LC) as a first-choice oper- ation, but converted to OC when necessary, and even began the operation using OC when neither LC nor SIOC were considered possible.
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Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study

Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study

This prospective observational comparative study was conducted in the Department of General Surgery at R.G. Kar Medical College and Hospital, India. All the relevant data were collected from January 2012 to June 2013. First, 50 patients were included in the study. Complete clinical history was recorded including all the relevant points, detailed physical examination was done, and the radiological and pathological investigation reports were recorded and analyzed. Written informed consent was taken from all patients. The study was approved by the Institutional Ethics Committee. 50 patients equally divided into two groups were taken up for the study. Then, patients were randomly divided into two groups: 25 cases (patients planned for conventional LC), i.e., LC group and 25 controls (patients planned for OC), i.e., OC group. In our study, patients were kept nil per orally (NPO) in the post-operative period till the bowel sounds appeared or flatus is passed whichever came first. Inclusion criteria were as follow: Patients aged 65 years and above, patients diagnosed as cases of symptomatic gallstone disease, patients with asymptomatic gallstones where cholecystectomy is indicated due to associated illnesses, and patients with asymptomatic gallstones with anticipated complications. Exclusion criteria were as follow: Patients with suspected GB carcinoma, gallstones associated with CBD stones (USG/MRCP proven or history of jaundice), patients with pancreatitis (serum amylase ≥ 3 times normal), and acute cholecystitis. Techniques of cholecystectomy
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Prediction of the Difficulties of Laparoscopic Cholecystectomy and the Possibility of Conversion to Open Cholecystectomy before Surgery using Ultrasonographic Criteria

Prediction of the Difficulties of Laparoscopic Cholecystectomy and the Possibility of Conversion to Open Cholecystectomy before Surgery using Ultrasonographic Criteria

admitted to the hospital with symptomatic gallstones could be treated by laparoscopic technique. There was no injury to the bile duct. Most relevant criteria for sonographic selection were the following: thickening of the wall of the gallbladder, diameter and number of the gallstones, position of the fundus of the gallbladder in relation to the caudal margin of the liver, diameter of the common bile duct and exclusion of intra abdominal adhesions by using a high-frequency ultrasound transducer. Sonographic criteria for exclusion were a completely stone-filled gallbladder, a scleroatrophic gallbladder, acute cholecystitis with wall- thickening without oedema and extensive intra abdominal adhesions in the right upper quadrant. Sensitivity of sonographic selection was 98.5%, specificity 97.6%.
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FREQUENCY OF CONVERSION TO OPEN CHOLECYSTECTOMY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY: - A RETROSPECTIVE ANALYSIS

FREQUENCY OF CONVERSION TO OPEN CHOLECYSTECTOMY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY: - A RETROSPECTIVE ANALYSIS

cholecystectomy being a newer method of surgery has its own limitations in terms of steep learning curve, availability of instruments and dependence of sight only etc, sometimes becomes less efficient way of operating on patients with gall stones disease. So there come the need for conversion to open method, which being one the most common procedures performed by a surgeon is more reliable and has more options available in cases of complications in laparoscopic technique. The conversion rates depend on the acuteness of gall stone disease, skill level of surgeon and anatomy of the biliary tract 6,7 . There has been a lot research done by different
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Study on preoperative factors predicting the conversion of laparoscopic cholecystectomy to open cholecystectomy

Study on preoperative factors predicting the conversion of laparoscopic cholecystectomy to open cholecystectomy

“Cholelithiasis is a common disease throughout the Western world. Gallstones can be found in 10% to 20% of the western population at some stage of life. In both sexes the prevalence increases with age; however, overall gallstones are more common in females than in males with a ratio of 4:1. Obesity and family history are also significant risk factors. The prevalence of gallstones is related to many factors like age, gender, ethnicity. Many factors predispose to the development of gallstones. They include obesity, pregnancy, dietary factors, Crohn's disease, terminal ileal resection, gastric surgery, hereditary spherocytosis, sickle cell disease, and thalassemia”.
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A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

A comparative study between open and Laparoscopic cholecystectomy in gallstone disease

Gastro-intestinal surgery has undergone a revolution in the recent years by the introduction of laparoscopic techniques. The concept of “keyhole surgery” created an immediate disparity between the potential of the new technique and training of surgeons to perform it. Now modern surgical methods are aimed at giving cure along with minimal invasive techniques with patient in mind, safety never being compromised. Cholelithiasis, which continues to be one of the most common digestive disorders encountered, was traditionally being dealt by conventional or open cholecystectomy. With the introduction of laparoscopic cholecystectomy, the surgical community witnessed a revolution in basic ideology and the importance of minimal access surgery.
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Intraoperative difficulties in laparoscopic cholecystectomy

Intraoperative difficulties in laparoscopic cholecystectomy

The reason for conversion was dense adhesions around the gallbladder and in callot's triangle which made dissection extremely difficult and completely hampering the proceedings. Significant factors which increased the operating time were: previous abdominal surgery, intrahepatic gallbladder, multiple large calculi, and very thick walled gallbladder. In all of these cases the P value was < 0.05. Two other factors which came out to be significant were anomalous vessels and large and distended gallbladder. But these two factors did not increased the operating time individually. Small sample size made anomalous vessels significant and patients having large and distended gallbladder were not time consuming to extract them from the abdominal wall. But two factors acute cholecystitis and abnormal callot's anatomy are above all of them and did not come out to be significant. The reason can be explained as maximum numbers of cases were converted to open cholecystectomy because of acute cholecystitis and abnormal callot's anatomy and the mean operating time was also high in both the groups which were almost equal to the mean operating time of the difficult cases.
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Prospective study of Various Factors Predicting Difficult Laparoscopic Cholecystectomy & Various Methods to Deal with Difficult Cholecystectomy

Prospective study of Various Factors Predicting Difficult Laparoscopic Cholecystectomy & Various Methods to Deal with Difficult Cholecystectomy

standard of cure for symptomatic cholelithiasis. With the ever increasing horizons of laparoscopic skills & expertise, laparoscopic cholecystectomy has emerged as the surgery of choice in conditions hitherto considered relative contraindication for laparoscope i.e. acute & gangrenous cholecystitis as evidenced by trials conducted by Manager et al, Chahin F et al, Singer J A et al, Willsher P C et al, Cox M r et al. However there are times when, even with the best technical expertise, conversion from laparoscopic to open cholecystectomy becomes inevitable to ensure patients safety. Such a conversion should not be viewed as a failure; rather a matter of sound surgical judgement, as patient safety is of foremost importance. The rates of conversion quoted in various studies range from 2 to 15 %. Several studies have evaluated the risk factors contributing to conversion from laparoscopic cholecystectomy to open cholecystectomy. Comparison with studies assessing the role of various risk factors: David S Kauvar et al assessed the applicability of laparoscopic cholecystectomy in geriatric population & described increased risk of conversion in patients aged 60 years or older. In our study conversion rate in patients aged 60 or more [10.25%] is high as compared to patients aged less than 60 [6.67%] years old. The increased risk of conversion in elderly patients may be due to chronicity of gall bladder disease, recurrent attacks of cholecystitis& more fibrotic adhesions. Epure O et al described male gender as a difficulty factor for laparoscopic cholecystectomy. Our study doesn‟t agrees with them showing that conversion to open cholecystectomy in male is 7.24% as compared to female 7.08%. The exact reason for greater conversion in males remains unexplained, although
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Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications

Early LC is safe and feasible in the treatment of acute cal- culous cholecystitis. The risk of postoperative complica- tions is increased by risk factors like male gender, high age and impaired renal function and conversion to open sur- gery. Of these factors the only one that can be influenced is conversion. Manifestations of advanced cholecystitis like high CRP, gangrene of the gallbladder or abscess formation increase the risk of conversion to open cholecystectomy. Early identification and treatment of acute calculous chole- cystitis might lower the number of patients with advanced cholecystitis and thus reduce the amount of converted pa- tients and postoperative complications. When LC cannot be performed safely conversion should be initiated to minimize the risk of bile duct injuries. Also enough atten- tion should be paid to surgeons in training learning appro- priate technique for performing open cholecystectomy.
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Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

Comparative study of morbidity of laparoscopic versus open cholecystectomy in complicated gallstone disease

This study was carried out in Surgical Unit- IV, Liaquat University Hospital Jamshoro, Hyderabad, from January 2008 to December 2009. It consisted of 100 patients with complicated gall stone disease. They were divided into two groups of 50 patients each; Group A for open and group B for laparoscopic cholecystectomy. Detailed his- tory was taken from all the patients with special regard to the abdominal pain or pain in right hy- pochondrium, lump in right hypochondrium, vom- iting, dyspepsia and fever. Thorough clinical ex- amination was done. Right hypochondrium was especially examined for assessment of Murphy’s sign, palpable mass and visceromegaly. Systemic review was also done to see any co-morbidity.
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Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists

Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists

Albeit generally regarded as a safe procedure, cholecystec- tomy may result in adverse outcomes with non-negligible morbidity and occasional mortality. Compared to traditional open cholecystectomy, laparoscopy minimised the periopera- tive mortality and duration of hospitalisation and allowed for an earlier return to normal activities with cosmetically accept- able results. A large Italian series including over 13,600 pa- tients (86.1% of them operated laparoscopically) reported 2.1 and 2% rates of medical and surgical 30-day complications, respectively; the advantage of laparoscopy was consistent across age groups, severity of gallstone disease and previous surgeries, and insignificant for emergency admissions and systemic complications in the elderly [2]. In other studies, compared to the 7.7% overall complication rate after open cholecystectomy, the laparoscopic cholecystectomy- associated morbidity ranged from 1.9 to 6.5%. The risk of developing postoperative adverse events is independent from surgeon and hospital volume, and is related to emergency conditions and to patient factors, such as advanced age, male gender, comorbidities (including obesity and cirrhosis), biliary inflammation and fibrotic gallbladder. Also, in patients with acute cholecystitis, the postoperative morbidity, mortality and
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A Retrospective Study on Comparison of Outcomes of Open Partial Cholecystectomy with Complete Cholecystectomy

A Retrospective Study on Comparison of Outcomes of Open Partial Cholecystectomy with Complete Cholecystectomy

cholecystitis. With the advent of the laparoscopic age, laparoscopic cholecystectomy (CL) was passed and most operations were performed with this method. However, since the use of LC a higher proportion (20-50%) of cholecystectomies have been documented. Upper abdominal adhesions are not possible in patients with open surgical operations. If urgent conversion is required, the patient has a heavier rejection of peritonitis, cholangitis, and open cholecystectomy. Open cholecystectomy is mainly performed in patients with inadequacy to complete the procedure due to contraindications to LC or LC and in patients who suffer from Mirizzi Syndrome and patients who require conversion in patients suffering from xanthogranulomatous cholecystitis.During OC or LC cholecystectomy, sometimes there is excessive inflammation, fibrosis and increased vascularization. There is a high risk of damaging the biliary system or damaging the hepatic vessels, preventing the dissection of the lime triangle. In these conditions, the safest procedure in our thinking will be partial cholecystectomy. Partial cholecystectomy is a frequently performed procedure and is well documented in the literature. The aim of our study is to investigate the frequency, indications and outcomes of partial open cholecystectomy in our hospital and whether it is an effective, safe and cost effective method.
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Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Laparoscopic cholecystectomy not only is the corner- stone of management of biliary disease and cholecystitis but is one of the commonest operations in both elective and emergency surgery. It offers an unquestionable ad- vantage over open cholecystectomy to the patient and the health care system [1]. It is essential therefore that simple metrics can be applied to understanding the course of surgery and its outcome. While completion of the operation laparoscopically is not a proven quality in- dicator, analysis of surgical performance needs greater scrutiny [2–4]. Outcomes from cholecystectomy, par- ticularly in terms of operative approaches and findings, use of intra-operative cholangiography, conversion from laparoscopic to open, length of surgery and morbidity, in- cluding readmission to hospital, vary. There are many var- iables in the management of cholecystitis, requiring a tailored approach due in part to the large heterogeneity of the patients and the actual state of the gallbladder at sur- gery. Interpreting the cause of and reducing this variability is a key to advancing outcomes following laparoscopic cholecystectomy.9 Conversion to open cholecystectomy is itself not only occasionally a necessity but a safer op- tion than proceeding laparoscopically. Surgeons, with far greater exposure to laparoscopic technique, may opt for different damage control procedures rather than conversion to open, including various forms of bailout techniques [5].
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Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

Open cholecystectomy for all patients in the era of laparoscopic surgery – a prospective cohort study

The strength of this report is the inclusion of all cholecys- tectomies performed in one unit with emergency admis- sion during a two-year period. Mini-laparotomy cholecystectomy is usually defined as open cholecystec- tomy through an incision of 4 to 7 cm[8,13] or less than 6 cm[18]. In this prospective and consecutive series, median length of incision was 7 cm for elective operations and 8 cm for acute operations. This demonstrates that sur- gical training and safety were prioritised in the present study, and it also indicates possibilities of further improvements in day-case rate and convalescence. Operation time included intra-operative cholangiography in 96% of the cases, common bile duct exploration in 19%, and training of surgical residents in 71% of all oper- ations. The complication rate in this series was six percent. Eight of 17 complications were wound infections of minor clinical importance (Clavien grade I). In previous randomised controlled trials comparing mini-laparotomy cholecystectomy and laparoscopic cholecystectomy com- plication rates between 3 and 20% have been observed without significant difference between the two tech- niques[2,3,19-22]. Total hospital stay in our study was 3.1 days (mean) with 12% of all procedures done as day- cases. These figures compare favourably with national sta- tistics for gallbladder surgery. In 2002, 12,357 cholecys- tectomies were done in Sweden, and 9,836 of these were completed laparoscopically[23]. The day surgery rate for laparoscopic cholecystectomy was 17%, or 13% of all cholecystectomies. The mean hospital stay was 2.7 days for laparoscopic cholecystectomy, 8.8 days for open cholecystectomy, and 4.4 days for all cholecystecto- mies[24], i.e. approximately one day longer than in our study.
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