Ramachandran, K (2020) Factors Necessitating Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION: Gallstone disease are a common gastrointestinal illness in the general population which frequently requires hospitalization. The prevalence is around 11% to 36%. The treatment of choice for patients with symptomatic cholelithiasis is Laparoscopic cholecystectomy. Previously Open cholecystectomy was frequently performed but that has given way to a laparoscopic approach. The advantages of laparoscopic cholecystectomy are the avoidance of large incision, shortened hospital stay and earlier recovery. The patients condition, the surgeon is level of experience, and technical factors can play a major role in the decision for conversion. Inability to define the anatomy and difficult dissection are the leading cause for conversion followed by other complications like bleeding. The conversion rate for elective laparoscopic cholecystectomy is around 5%, whereas the conversion rate in the setting of complications like acute cholecystitis is around 30%. The goal of this study was to determine the conversion rate and identify the factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy. Hence, these findings will allow us to: 1. To identify a patients risk for conversion based on preoperative information leading to more meaningful and accurate preoperative counselling. 2. Improved operating room scheduling and efficiency. 3. Improve patient safety by minimizing time to conversion. AIMS AND OBJECTIVES: 1. To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery. 2. To determine the rate of conversion of laparoscopic cholecystectomy to open surgery. MATERIALS AND METHODS: All patients admitted in Thanjavur Medical College Hospital. A total of 75 patients presenting with symptomatic gall stone disease (Age >18 yrs) without choledocholithiasis between December 2017 and October 2019 were included in the study. CONCLUSION: Patients presenting on admission with acute cholecystitis had a higher rate of conversion. An ultrasound finding suggestive of a thickened gallbladder wall is a good indicator of conversion.Therefore ultrasonography can predict difficult laparoscopic cholecystectomy and thus the likelihood of conversion to open surgery. The main reason for conversion from laparoscopic cholecystectomy to open procedure was difficult anatomy due to dense omental adhesions. Conversion from laparoscopic cholecystectomy to open procedure should not be visualized as a complication but rather it should be considered a reflection of sound surgical judgment in difficult cases. However, laparoscopic cholecystectomy is a safe and minimally invasive technique, with low conversion rate and the most common cause of conversion in our study was the presence of dense adhesions at Calot's triangle.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711210 |
| Uncontrolled Keywords: | Cholecystectomy, laparoscopy, Gall stones, cholecystitis, , Common bile duct, cystic duct, Critical View of Safety, Bile duct injury, Gall Bladder, Cystic Artery, Calot’s Triangle. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 16:46 |
| Last Modified: | 10 Feb 2021 16:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13999 |
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