Determinants for Predicting the Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy - A Prospective Study


Sandeep Kumar Goyal1 , Gopal Singhal2 , Bhanu Pratap Sharma3 , Dinesh Mohan4 , Savita5 , Pooja6

BACKGROUND Laparoscopic surgery is a kind of minimal access surgery that obviates various complications which are encountered during open method, but the outcome of procedure varies according to condition of the patient. Knowledge of these factors may be used for the preoperative counselling of the patients regarding the successful outcome of the surgery as well as to herald the risk of conversion before undertaking patients. We wanted to evaluate the various preoperative factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. METHODS A total of 100 patients of both sexes, from all age groups and socio-economic status was included in the study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was done for each included patient and score was given according to their signs and symptoms. Patients were categorised subsequently into mild (group 1 & 2), moderate (group 3 & 4) and severe (group 5) difficulty as per scoring method. RESULTS The mean age was 46.21 ± 13.36, ranging between 20 years to 80 years (95 % CI 43.56 to 48.86) with 89 females and 11 males. Among the converted group, 3 (18.75 %) participants were > 60 years of age and 2 (2.38 %) participants were of age < 60 years. According to patient's expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as mild, moderate and severe. A total of 81 patients were categorised as mild, 17 as moderate and 2 as severe. Conversion rate is 0 % in mild difficulty group, 17.64 % in moderate difficulty group and 100 % in severe difficulty group. CONCLUSIONS Difficulty and conversion risk may be predicted accurately by using the scoring system. Surging scores indicated marked increase in difficulty levels intraoperatively and thus affects the conversion rates. Thus, it can be concluded that the scoring system accurately assessed the conversion rates of laparoscopic cholecystectomy preoperatively to open surgery. Higher scores indicated increase in difficulty level.