Vishnuvarthan, S (2013) Study on the Conversion of Laparoscopic Cholecystectomy owing to per operative complications. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: In the modern medical era, laparoscopic approach to surgical conditions have reached to a height that it is performed even for malignant conditions. The Minimal access Surgery which has grown up from minimally invasive surgery has given us the faith that nearly all surgeries can be done by laparoscopy. The first laparoscopic cholecystectomy was done by Prof. Dr.Med Erich Muhe of Germany in the year 1985. He has been awarded the German surgical society anniversary award in the year 1992. The laparoscopic cholecystectomy is performed by two different techniques, (A) The DA VINCI system, (B) The BONATI system. About ten lakh cholecystectomies are performed ever year, of which 96% are done by laparoscopic method. laparascopic cholecystectomy is the most common laparoscopic procedure that is done today in the modern medical era. By number of studies and research works, it is stated that laparoscopic cholecystectomy is superior to conventional open method because of its advantages like smaller incisions, early recovery, less post operative pain and hospital stay, better cosmesis. However laparoscopic cholecystectomy also has got its own disadvantages and complications. In 1992, a NIH consensus conference held in Bethesda approved laparoscopic cholecystectomy as the treatment of choice for symptomatic cholelithiasis. Conversion to open technique is a major morbidity of laparoscopy as it looses its supremacy over open technique once the conversion takes place.With growing experience of laparoscopic cholecystectomy and completion of the learning curve, the indications for laparoscopic cholecystectomy have been extended approaching that of opaen cholecystectomy. Complications of laparoscopic cholecystectomy have been minimized to as low as 2-6%.3 However, a substantial proportion of patients had to be converted to open operation because of technical difficulties or intraoperative complication. Conversion rates of 2.6% to 14% had been described in different studies. The factor to be considered with conversion is that it should never be considered a complication, but rather a correct judgement by the surgeon. AIM OF THE STUDY: The aim of the present study is 1. To study the incidence of conversion of laparoscopic Cholecystectomy. 2. To analyse the reasons for the conversion of laparoscopic cholecystectomy owing to per operative complications like, a. Arterial injury, b. Hepato biliary tract injury, c. Dense adhesions, d. Aberrant anatomy, e. Technical issues. MATERIALS AND METHODS: The study was conducted in the patients who underwent laparoscopic cholecystectomy from November 2011 to November 2012 in the department of general surgery, Government Stanley Hospital. There were totally 100 patients of which are males and are females. The study has been done after the patients informed consent. All these patients were evaluated in a proper manner as given in the proforma and have been assessed pre operatively and operated under perfect anaesthetic fitness. This study mainly focusses on the patients who have been converted to open method. They were analysed further regarding the reasons for conversion to open method due to per-operative complications. INCLUSION CRITERIA: i. All patients with syptomatic gallstone disease ii. Asymptomatic gallstone disease in patients with type 2 DM. iii. Benign gall bladder disease like gallbladder polyp EXCLUSION CRITERIA: i. Patients who had undergone previous upper GI surgeries ii. Patients with known liver diseases METHODOLOGY : • All patients admitted in SMC-GS ward with a diagnosis of cholelithiasis in the time period of November 2011 – November 2012 are included in this study. Thorough history and clinical examination was done. • Admission baseline blood investigations was done. Liver function test was done in all patients. • As per the standard protocol all patients were treated with medical and surgical care as available in institution. All patients were subjected to ultrasonogram abdomen and upper GI endoscopy. • CECT abdomen was done in patients with suspected pancreatic/common bile duct pathology. • MRCP was done in patients with elevated alkaline phosphatase and dilated CBD/associated CBD pathology. • Consent regarding conversion if necessary was also obtained in all cases. OBSERVATION AND RESULTS: From November 2011 – November 2012, a total of 98 patients had undergone laparoscopic cholecystectomy in the Department of General Surgery, Government Stanley Hospital. Out of 98 patients who underwent laparoscopic cholecystectomy 13 patients (13.26 %) were converted to open cholecystectomy owing to per-operative complications. The reasons for conversions are listed in the (Table 1and Chart 1). Of these 98 patients 36 were males and 62 were females, out of which 6 males and 7 females were converted into open cholecystectomy i.e., 6.12% males and 7.14% females of total cases. when taken in terms of number of males and females who got converted male and female percentage were 16.66% and 11.29% (Table 2 and Chart 2). respectively. The least age patient in our study is 16 and the highest age patient is 70. The conversion was higher in 40-50 age group (46.15% of total conversion) and was low in 30-40 age group (15.38% of total conversion) patients. Conversion was not done in 10-20 age group and 60-70 age group patients. highest number of patients who underwent laparoscopic cholecystectomy were in 30-40 age group. (Table 3 and Chart 3). All patients underwent cholecystectomy as an elective case. Though some morbidity was there in terms of post operative complications which we are not analyzing , no mortality was reported. CONCLUSION: After analyzing the results of our study, • We conclude that the incidence of conversion of laparoscopic cholecystectomy is 13.26 %. • The reasons for conversion in descending order of frequency are: 1. Dense adhesions (5.1%), 2. Difficult anatomy around calot’s triangle (3.06 %), 3. Arterial injury (3.06 %), 4. Hepato-biliary injury (1.02 %), 5. Technical issues (1.02 %).
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Conversion ; Laparoscopic Cholecystectomy ; owing ; per operative complications. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 03 Apr 2018 04:36 |
| Last Modified: | 03 Apr 2018 04:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6813 |
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