Syed Sheeraz ur Rahman¹, Zahid Habib¹, Rufina Soomro¹ and Omer Bin Khalid²

ABSTRACT

Objective: To identify peri-operative risk factors leading to conversion in patients undergoing laparoscopic cholecystectomy.

Study Design: Observational / descriptive study.  

Place and Duration of Study: This study was conducted at the Liaquat National Hospital & Medical College, in Karachi from Jan 2009 to Dec 2011. 

Materials and Methods: The Study was started after formal approval of General Surgery faculty. Theater records of all patients who underwent Laparoscopic to open conversion admitted to the department, Liaquat National Hospital & Medical College, from January 2009 to December 2011 were retrieved & reviewed. All data was entered into a designated proforma and SPSS ver 19.0 was used for statistical analysis.  

Results: During the period from January 2009 to December 2011 (3 years), total 1281 patients admitted for cholecystectomies. Out of which 156 patients had planned open cholecystectomies and were therefore excluded from the study. 1125 patients underwent laparoscopic cholecystectomies out of which n=45 were converted to open cholecystectomies with the conversion rate of 4%. In our series,  males were 20 and females were 25 with mean age of 48.20 ± 13.048. 36 patients were admitted through the OPD with the mean hospital stay was 8.56 ± 5.294 days. Pre-surgery 28 of the patients had acute symptoms and 31 patients had normal liver function tests at the time of admission. 33 patients did not show any ultrasound evidence of acute cholecystitis. All patients were operated in direct supervision of the consultant with minimum experience of performing > 500 laparoscopic cholecystectomies. Intraoperative causes leading to conversion were difficult anatomy in 44 patients, empyema in 17, perforated gall bladder in 5) , bleeding in 4 and instrument failure in  1. 17 of the patients required per-operative cholangiogram (POC)for deranged LFTS and for delineation of difficult anatomy.  

Conclusion: Laparoscopic cholecystectomy in a tertiary care hospital has acceptable conversion rates as compared to local and international standards. In our series, patients with difficult per-operative anatomy and empyema gallbladder were significant risk factors for conversion. 

Key Words: Open conversion, laparoscopic cholecystectomy, risk factors

Citation of article: Rahman SS, Habib Z, Soomro  R, Khalid OB. Revisiting Factors Predicting Conversion to