CONVERSION FROM LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN SURGERY: REASONS AND POSSIBLE RISKS: A SINGLE CENTER EXPERIENCE

Abstract

Laparoscopic cholecystectomy has grown in popularity since its introduction and has become the gold standard surgical method for the treatment of cholelithiasis. It has several advantages over open surgery, including less postoperative pain, a shorter hospital stay, a faster return to normal activities, and bettercosmetic results. Converting from laparoscopic to open surgery may be necessary in some cases, either to prevent or treat difficulties. The current conversion rate from laparoscopic to open surgery is between 2 and 15%. Open surgery may be required due to advanced age, male gender, acute cholecystitis, anatomicalalterations of the gallbladder or biliary system, obesity, bleeding, adhesions, and biliary tract injuries. The purpose of our study was to determine the risk factors that influencethe conversion to open surgery.Between January 2018 and December 2021, 921 cholecystectomy cases were analyzed retrospectively at the Recep Tayyip Erdogan University Training and Research Hospital. Twenty-three of thesepatients were removed from the study once it was revealed that they had undergone direct open surgery or an open cholecystectomy while undergoing another operation. There were 28 patients in the study who had a laparoscopic cholecystectomy but had to convert to open surgery due to difficulties. The demographic and clinicalinformation about the patients was obtained from hospital records. By comparing the data of an equal number of randomlyselected patients from laparoscopic completed patients, it was assessed if these features had a significant effect on the conversion from laparoscopic to open surgery.The most common reason for conversion from laparoscopic to open cholecystectomy was adhesion due to inflammation, which accounted for 3.04 percent of conversions. In our study, cholecystitis symptomsincludingnumerous calculi on ultrasonography and increased wall thickness, as well as raised GGT and ALP levels, all affected the decision to convert to open surgery. There were no significant associationsdiscovered between gender, pancreatitis, cholangitis, stone size, and ASA score. The duration of hospitalization was found to be considerably longer in the group that converted to open surgery.Increased rates of conversion to open surgery are associated with advanced age, obesity, previous episodes of cholecystitis, adhesions due to previous abdominal incisions, presence of cholecystitis findings such as multiple calculi on ultrasonography and increased wall thickness, and high GGT and ALP values. The most effective factor in converting to open surgery appears to be having previously had cholecystitis. Preoperative patient examination can aid in predicting the risk of exposure.

Keywords

• Open cholecystectomy
• laparoscopic cholecystectomy
• risk factors

References

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