CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN ASSOCIATION WITH OLD AGE, MALE GENDER AND OBESITY
Main Article Content
Keywords
Laparoscopic Cholecystectomy, Conversion to Open Cholecystectomy, Old Age, Male Gender, Obesity
Abstract
INTRODUCTION: Laparoscopic cholecystectomy is regarded as the "gold standard" surgical intervention for the management of cholelithiasis. Yet, sometimes it is impossible to proceed with laparoscopic surgery and the procedure needs to be converted to conventional open technique to avoid complications or to treat complications. Few recent studies claimed that old age, male gender and obesity were associated with increased frequency of conversion and advocated their potential role in the risk stratification and pre-operative planning in future surgical practice.
OBJECTIVES: The objectives of this study were to determine association of old age, male gender and obesity with conversion of laparoscopic cholecystectomy to open cholecystectomy
MATERIAL AND METHODS
It was a prospective cohort study. It was conducted at Department of Surgery, Ghurki Trust Teaching Hospital affiliated with Lahore Medical and Dental College, Lahore. Patient data was collected from 01/07/2019 to 30/06/2020.
This study involved 139 patients of both genders aged between 18-70 years All patients underwent conventional 4 port laparoscopic cholecystectomy. The outcome variable was frequency of conversion of laparoscopic procedure to open cholecystectomy (due to obscured anatomy/uncontrolled bleeding/visceral injury) which was noted and compared across old age (≥60 years), male gender and obesity.
RESULTS: The mean age of the patients was 41.8±16.1 years. There were 38 (27.3%) male and 101 (72.7%) female patients with a male to female ratio of 1:2.7. 26 (18.7%) patients were obese and 31 (22.3%) patients were aged ≥60 years. Conversion to open cholecystectomy was required in 10 (7.2%) patients undergoing laparoscopic cholecystectomy. The frequency of conversion of laparoscopic cholecystectomy to open procedure was significantly higher in patients with age ≥60 years (16.1% vs. 4.6%; p-value=0.029), male gender (15.8% vs. 4.0%; p-value=0.016) and obesity (19.2% vs. 4.4%; p-value=0.008). Similar difference in the frequency of conversion to open cholecystectomy with old age (≥60 years), male gender and obesity was noted across various subgroups of patients based on duration of disease and ASA status.
CONCLUSION: In the present study, the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be significantly higher in patients with old age, male gender and obesity which advocates consideration of such patients at higher risk of conversion so that anticipated pre-operative preparation for open cholecystectomy and relevant informed consent may decrease the morbidity of unplanned open surgery as well as reduce the associated patient anxiety and dissatisfaction in this scenario in future surgical practice.
References
2. Ali A, Saeed S, Khwaja R, Samnani SS, Farid FN. Difficulties in laparoscopic cholecystectomy: conversion versus surgeon’s failure. J Ayub Med Coll Abbott 2016;28(4):669-71.
3. Thyagarajan M, Singh B, Thangasamy A, Rajasekar S. Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy. Int Surg J 2017;4(10):3354-7.
4. Abdulhussein BJ, Hussein YF, Nawar AH, Al-Naggar RA. Conversion rate of laparoscopic cholecystectomy to open surgery at Al Karamah Teaching Hospital, Iraq. Surg Sci 2015;6:221-6.
5. Awan NA, Hamid F, Mir IN, Ahmad MM, Shah AA, Asimi A, et al. Factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy-institution based study. Int Surg J 2018;5(1):132-7.
6. Maitra TK, Ekramullah M, Mondol SK. Factors determining conversion of laparoscopic to open cholecystectomy. IMC J Med Sci 2017;11(2):32-5.
7. Al Ghadhban MR, Alkumasi HA, Meziad MS. Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital. Int Surg J 2018;5(5):1640-3.
8. Jamil M, Niaz K, Ali A, Saeed S. Laparoscopic cholecystectomy for acute cholecystitis: early versus delayed. Rawal Med J 2014;39(2):199-202.
9. Chhajed R, Dumbre R, Fernandes A, Phalgune D. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a comparative study. Int J Surg 2018;5(10):3381-5.
10. Arafa AS, Khairy MM, Amin MF. Emergency versus delayed laparoscopic cholecystectomy for acute cholecystitis. Egypt J Surg 2019;38(2):171-9.
11. Jee SL, Jarmin R, Lim KF, Raman K. Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis: a randomized prospective study. Asian J Surg 2018;41(1):47-54.
12. Damani SA, Haider S, Bilal H, Perveen S. Comparison of operative time and length of hospital stay in laparoscopic cholecystectomy in acute verses chronic cholecystitis. J Ayub Med Coll Abbott 2015;27(1):102-4.
13. Afzal M, Mustafa MN, Zaidi AH, Chaudhry IA, Hani MS, Shaikh SA, et al. Outcome of early laparoscopic cholecystectomy for acute cholecystitis. J Islamabad Med Dent Coll 2016:5(1):17-20.
14. Al-Qahtani HH. Early versus interval cholecystectomy after mild acute gallstone pancreatitis: a 10 year experience in central Saudi Arabia. J Taibah Univ Med Sci 2014;9(4):322-7.
15. Ozkardes AB, Tokaç M, Dumlu EG, Bozkurt B, Ciftçi AB, Yeti F, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg 2014;99:56–61.
16. Macafee DA, Humes DJ, Bouliotis G, Beckingham IJ, Whynes DK, Lobo DN. Prospective randomized trial using cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg 2009;96(7):1031-40.
17. Khan SSA. Early versus delayed cholecystectomy for acute cholecystitis, a prospective randomized study. Pak J Gastroenterol 2002;16(2):30-4.
18. Ghazanfar R, Tariq M, Ghazanfar H, Malik S, Changez M, Khan JS. Role of different factors as preoperative predictors of conversion of laparoscopic cholecystectomy to open cholecystectomy. Arch Med Health Sci 2017;5:157‑60.
19. Maitra TK, Ekram Ullah M, Faruquzzaman, Mondol SK. Operative and postoperative complications of laparoscopic cholecystectomy: experience from a tertiary care hospital of Bangladesh. Bangladesh Crit Care J 2017;5(1):11-6.
20. Farooq U, Rashid T, Naheed A, Barkat N, Iqbal M, Sultana Q. Complications of laparoscopic cholecystectomy: an experience of 247 cases. J Ayub Med Coll Abbott 2015;27(2):407-10.
21. Rashid T, Naheed A, Farooq U, Iqbal M, Barakat N. Conversion of laparoscopic cholecystectomy into open cholecystectomy: an experience in 300 cases. J Ayub Med Coll Abbott 2016;28(1):116-9.
22. Zaidi AH, Halim A, Azami R, Rana SH, Naqvi S, Shan A. Complications in laparoscopic cholecystectomy. APMC 2015;9(2):57-65.
23. Radu D. Laparoscopic Cholecystectomy, rate and predictors for conversion. Surg Endosc 2016;4(5):1039.
24. Gill HS, Gupta A, Singh B. Evaluation of the role of various factors in conversion of laparoscopic cholecystectomy into open cholecystectomy. Int J Contemp Med Res 2016;3(10):3031-5.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Zubair Fayyaz
Senior Registrar, Department of Surgery, Lahore Medical & Dental College, Lahore
Omar Zafar
Senior Registrar, Department of Surgery, Azra Naheed Medical College, Lahore
Ahmad Zaeem
Resident, Department of Surgery, Lahore Medical & Dental College, Lahore
Rooh ul Ain
Assistant Professor, Department of Surgery, Lahore Medical & Dental College, Lahore
Wasif Majeed Chaudhry
Professor, Department of Surgery, Lahore Medical & Dental College, Lahore
Ch Muhammad Aqeel
Associate Professor, Department of Surgery, Azra Naheed Medical College, Lahore
Muhammad Shoaib
Professor, Department of Surgery, Azra Naheed Medical College, Lahore
Zahid Mahmood
Professor, Department of Surgery, Lahore Medical & Dental College, Lahore