Risk factors of conversion in laparoscopic cholecystectomies for lithiasic acute cholecystitis. Results of a monocentric study and review of the literature.

##plugins.themes.academic_pro.article.sidebar##

Published Jun 21, 2019
Download
pdf
Vol. 97 No. 2 (2019): Issue Feb 2019

##plugins.themes.academic_pro.article.main##

Mohamed Salah Jarrar
Amine Fourati
Houssem Fadhl
Sabri Youssef
Mohamed Mahjoub
Hosni Khouadja
Alaeddine Hafsa
Mohamed Hedi Mraidha
Amine Ghali
Fehmi Hamila
Rached Letaief

Abstract

Introduction. Nowadays, laparoscopic cholecystectomy has become the gold standard in the management of lithiasic acute cholecystitis. However, the rate of conversion to laparotomy remains considerable, greater than that of uncomplicated lithiasis. Some factors, related to the patient, the disease or the surgeon, are associated with a high risk of conversion.
Aim: To identify the factors associated with a significant risk of conversion in laparoscopic cholecystectomy for acute cholecystitis.
Methods. Between January 2011 and December 2015, all patients operated on for acute cholecystitis at the Department of General and Digestive Surgery of Farhat Hached University Hospital of Sousse - Tunisia were divided into two groups: A for the laparoscopic approach and B for conversion. We compared the two groups.
Results. The conversion rate was 21.9% (43 patients). At the end of this work, we found that the conversion rate was significantly increased for males (p = 0.044), ulcerative disease (p = 0.004), smokers (p = 0.007), ASA score = II (p = 0.005), abdominal guarding (p = 0.001), fever (p = 0.001), perivesicular effusion on ultrasound (p = 0.041), ultrasound Murphy's sign (p = 0.023), delayed cholecystectomy (p = 0.038), perivascular adhesions (p <10-3) and gangrenous cholecystitis (p = 0.009).
Conclusion. The conversion is sometimes badly perceived by the surgeon. However, it should in no way be considered a failure, but rather a change of strategy to ensure patient safety. Conversion should not be delayed, especially as risk factors have been identified.

Keywords:

Lithiasic acute cholecystitis; Laparoscopy; Conversion; Risk factors

##plugins.themes.academic_pro.article.details##

References

  1. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007;14:91-7.
  2. Overby DW, Apelgren KN, Richardson W, et al. Guidelines for the clinical application of laparoscopic biliary tract surgery. Soc Am Gastrointest Endosc Surg 2010;24:2368-86.
  3. Atmaram DC, Lakshman K. Predictive Factors for Conversion of Laparoscopic Cholecystectomy. Indian J Surg 2011;73:423-6.
  4. Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 2001;181:520-5.
  5. Alponat A, Kum CK, Koh BC, Rajnakova A. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 1997;21:629-33.
  6. Sippey M, Grzybowski M, Manwaring ML, et al. Acute cholecystitis: Risk factors for conversion to an open procedure. J Surg Res 2015;199:357-61.
  7. Sutcliffe RP, Hollyman M, Hodson J, et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. Off J Int Hepato Pancreato Biliary Assoc 2016;18:922-8.
  8. Schäfer M, Krähenbühl L, Büchler MW. Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 2001;182:291-7.
  9. Domínguez LC, Rivera A, Bermúdez C, Herrera W. Analysis of factors for conversion of laparoscopic to open cholecystectomy: a prospective study of 703 patients with acute cholecystitis. Cirugía Española 2011;89:300-6.
  10. Kanaan S, Murayama KM, Merriam LT, et al. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res 2002;106:20-4.
  11. Goonawardena J, Gunnarsson R, De Costa A. Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors. Am J Surg 2015;210:492-500.
  12. Bickel A, Rappaport A, Kanievski I, et al. Laparoscopic cholecystectomy for acute cholecystitis performede by resdents in surgery: a risk factor for conversion to open laparotomy? Laparoendosc Adv Surg Tech 1998;8:137-41.
  13. Teckchandani N, Garg PK, Hadke NS, et al. Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: a prospective study. Int J Surg 2010;8:623-7.
  14. Goh YL, Toumi Z, Mok KW, Date RS. Variation in conversion rates of laparoscopic cholecystectomy in different set-ups can be explained on the basis of C-reactive protein (CRP) values at index admission. Int J Surg 2015;15:38-9.
  15. Suter M, Meyer A. A 10 years experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc 2001;15:1187-92.
  16. Cabellero MA, Del Olmo M , Blanco Alvarez JI, et al. Surgical treatment of the acute cholecystitis in the laparoscopique age. A comparative study : laparoscopie against laparotomy. Rev Esp Enferm Dig 1998;90:788-93.
  17. Fried GM, Barkun JS, Sigman HH et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 1994;167:35-41.
  18. Sanabria JR, Gallinger S, Croxford R, Strasberg SM. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg 1994;179:696-704.
  19. Eldar S, Sabo E, Nash M, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 1997;21:540-5.
  20. Zisman A, Gold-Deutch R, Zisman E et al. Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy? Surg Endosc 1996;10:892-4.
  21. Yang TF, Guo L, Wang Q. Evaluation of Preoperative Risk Factor for Converting Laparoscopic to Open Cholecystectomy: A Meta-Analysis. Hepatogastroenterology 2014;132:958-65.
  22. Vivek M, Augustine A, Ranjith R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg 2014;10:62-7.
  23. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188: 205-11.
  24. Low SW, Iyer SG, Chang SK, Mak KS, Lee VT, Madhavan K. Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates. Surg Endosc 2009;23:2424-9.
  25. Payen J-L, Muscari F, Vibert É, Ernst O, Pelletier G. Lithiase biliaire. Presse Med 2011;40:567-80.
  26. Fraser SA SH. Conversion in laparoscopic cholecystectomy after gastric resection: A 15-year review. Can J Surg 2009;52:463-6.
  27. Akyurek N, Salman B, Irkorucu O, al. Laparoscopic cholecystectomy in patients with previous abdominal surgery. J Soc Laparoendscopic Surg 2005;9:178-83.
  28. Bouassida M, Belghith O, Zribi S, et al. Facteurs prédictifs de conversion aux cours des cholécystectomie pour cholécystite aiguë lithiasique. J Chir 2015;152:36.
  29. Srikanth G, Kumar A, Khare R, et al. Should laparoscopic cholecystectomy be performed in patients with thick-walled gallbladder? J Hepatobiliary Surg 2004;11:40-4.
  30. Stanisic V, Andjelkovic I, Vlaovic D, et al. Feasibility of applying data mining techniques for predicting technical difficulties during laparoscopic cholecystectomy based on routine patient work-up in a small community hospital. Hepatogastroenterology 2013;60:1561-8.
  31. Kaafarani HMA, Smith TS, Neumayer L, Berger DH, Depalma RG, Itani KM. Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 2010;200:32-40.
  32. Beyrouti MI, Beyrouti R, Affes N, et al. La cholécystite aigue lithiasique : traitement laparoscopique (A propos de 106 cas). Tunis Med 2011;89:355-9.
  33. Thompson MH, Benger JR. Cholecystectomy, conversion and complications. J Hepatobiliary Pancreat Surg 2000;11:373-8.
  34. Brugère C, Slim K, Lacaine F. Quand et par quelle voie opérer une cholécystite aiguë lithiasique? Ann Chir 2003;128:549-50.
  35. Chung-Mau LO, Chi-Leung L, Edward CS, et al. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998:461-7.
  36. Johansson M, Thurne A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a pro- spective, randomised clinical trial. J Gastrointest Surg 2003;7:642-5.
  37. Jarrar MS, Chouchène I, Fadhl H, et al. Early versus delayed laparoscopic cholecystectomy for lithiasic acute cholecystitis during emergency admissions. Results of a monocentric experience and review of the literature. Tunis Med 2016; 94: 167-72.
  38. Shamiyeh A, Danis J, Wayand W et al. 14-Year analysis of laparoscopic cholecystectomy: conversion - when and why? Surg Laparosc Endosc Percutan Tech 2007;17:271-6.
  39. Peters JH, Krailadsiri W, Incarbone R, et al. Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg 1994;168:555-9.
  40. Eldar S, Eitan A, Bickel A, et al. The impact of patient delay and physician delay on the out come of laparoscopic cholecystectomy for acute cholecystitis. Am J Surg 1999;178:303-7.
  41. Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993;217:233-6.
  42. Singer JA, McKeen RV. Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 1994;60:326-8.