Abstract
Introduction
A higher rate of conversion to open surgery is a well-known problem in patients with acute cholecystitis undergoing laparoscopic cholecystectomy. The aim of this study is to analyze factors which may impact on conversion rates, and to analyze our outcomes following implementation of a departmental strategy in reducing conversion rates.
Materials and methods
122 patients with acute cholecystitis were considered for laparoscopic cholecystectomy from July 2003 to July 2007. An audit of the results of laparoscopic cholecystectomy was done in July 2005 and a departmental strategy aimed at reducing the conversion rates was introduced. The strategies included early laparoscopic cholecystectomy (within 72 hours of admission), performed or supervised by specialist hepatobiliary surgeons, and modifications of operative techniques. This study compares the conversion rates before and after that audit. Forty-eight patients (group A) were from the preaudit period and the remaining 74 (group B) were from the postaudit period. A multivariate analysis was performed to identify risk factors for conversion to open surgery and whether the strategies implemented resulted in decrease in conversion rates.
Results
In the group A patients, there was a conversion rate of 29.2%. Gallbladder wall thickness of greater than 5 mm was found to be a statistically significant (p = 0.028) risk factor for conversion to open surgery. In group B patients, the conversion rates were significantly lower at 6.75% (p = 0.001). Analyzing both groups of patients, using multivariate analysis, gallbladder wall thickness, increasing age, and preaudit operative period were found to be independently associated with conversion to open surgery.
Conclusions
This study demonstrated that, with specific strategies to decrease conversion and with technical improvements, the conversion rates can be decreased with no demonstrable difference in postoperative complications. Gallbladder wall thickness and increasing age are risk factors for conversion to open surgery.
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References
Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1998) Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc 8(3):200–207
Soffer D, Blackbourne LH, Schulman CI, Goldman M, Habib F, Benjamin R, Lynn M, Lopez PP, Cohn SM, McKenney MG (2007) Is there an optimal time for laparoscopic cholecystectomy in acute cholecystitis? Surg Endosc 21:805–809
Cheruvu CV, Eyre-Brook IA (2002) Consequences of prolonged wait before gallbladder surgery. Ann R Coll Surg Engl 84(1):20–22
Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18(9):1323–1327
Pavlidis TE, Marakis GN, Ballas K, Symeonidis N, Psarras K, Rafailidis S, Karvounaris D, Sakantamis AK (2007) Risk factors influencing conversion of laparoscopic to open cholecystectomy. J Laparoendosc Adv Surg Tech A 17(4):414–418
Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M (2001) Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 15(9):965–968
Yol S, Kartal A, Vatansev C, Aksoy F, Toy H (2006) Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery. JSLS 10(3):359–363
Stevens KA, Chi A, Lucas LC, Porter JM, Williams MD (2006) Immediate laparoscopic cholecystectomy for acute cholcystitis: no need to wait. Am J Surg 192(6):756–761
Lau H, Lo CY, Patil NG, Yuen WK (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc 20(1):82–87
Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, Al-Natour S (2002) Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A 12(3):193–198
Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H (2002) Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc 16(1):180–183
Knight JS, Mercer SJ, Somers SS, Walters AM, Sadek SA, Toh SK (2004) Timing of urgent laparoscopic cholecystectomy does not influence conversion rate. Br J Surg 91(5):601–604
Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S (2005) Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease. Br J Surg 92(5):586–591
Madan AK, Aliabadi-Wahle S, Tesi D, Flint LM, Steinberg SM (2002) How early is early laparoscopic treatment of acute cholecystitis? Am J Surg 183(3):232–236
Kitano S, Matsumoto T, Aramaki M, Kawano K (2002) Laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Surg 9(5):534–537
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21(5):540–545
Hadad SM, Vaidya JS, Baker L, Koh HC, Heron TP, Thompson AM (2007) Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis. World J Surg 31(6):1298–1301
Greenwald JA, McMullen HF, Coppa GF, Newman RM (2000) Standardization of surgeon-controlled variables: impact on outcome in patients with acute cholecystitis. Ann Surg 231(3):339–344
Feldman LS, Medeiros LE, Hanley J, Sigman HH, Garzon J, Fried GM (2002) Does a special interest in laparoscopy affect the treatment of acute cholecystitis? Surg Endosc 16(12):1697–1703
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Low, SW., Iyer, S.G., Chang, S.KY. et al. Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates. Surg Endosc 23, 2424–2429 (2009). https://doi.org/10.1007/s00464-009-0374-x
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DOI: https://doi.org/10.1007/s00464-009-0374-x