Preoperative and Operative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy

Abstract

Background: According to the world’s statistics, there are approximately 20 million people who are diagnosed with gallstones in the United States of America. Moreover, the occurrence of gallstones is 0.63/100 persons per year. According to research from Pakistan, the surgical occurrence of gallstones in females was 14.2 percent, and it was 4.2 percent in males. To treat gallstones, the gold standard treatment, which is used worldwide, is laparoscopic cholecystectomy (LC). It is important to have an understanding of and knowledge related to the preoperative and intraoperative factors that lead to conversion from LC to open cholecystectomy (OC). Objective: To study the risk factors (operative as well as pre-operative) that are associated with the conversion of laparoscopic cholecystectomy to open cholecystectomy. Study design: A cross-sectional study Place and Duration This study was conducted in Liaquat University Hospital Hyderabad from February 2022 to February 2023. Methodology: All of the participants of this study were diagnosed with symptomatic gallstones. Every patient was planned for laparoscopic cholecystectomy. There were a few operative factors, such as empyema, perforation, scleroatrophic (gross appearance of the gallbladder), and gallbladder adhesions. Furthermore, there were a number of pre-operative factors such as morbid obesity, age, previous endoscopic retrograde cholangiopancreatography (ERCP), liver function tests, previous upper abdominal surgery, alkaline phosphatase, total leukocyte count, alanine transaminase, severe sepsis, and total bilirubin. Results: There were a total of 1200 patients who were a part of this research. Among these 1200 patients, 92% successfully underwent laparoscopic cholecystectomy, while 8% had to undergo conversion to open cholecystectomy. The conversion rate in our study was 7.78 percent. The average age of the participants was 41.6 years. Morbid obesity was the most significant risk factor associated with the conversion. The most common reason for the conversion was finding difficulty in defining anatomy. Conclusion: Although laparoscopic cholecystectomy is the gold standard for treating gallstones, open cholecystectomy is a safer approach for people who are diagnosed with complicated gallbladders.