Per-Operative Predictors of Conversion of Laparoscopic Cholecystectomy into Open Procedure

Abstract

Laparoscopic cholecystectomy, a minimally invasive procedure for gallbladder removal, is widely preferred due to its advantages like reduced postoperative pain and quicker recovery. However, in certain cases, this procedure may need to be converted to an open cholecystectomy. The ability to predict such conversions preoperatively is crucial for better surgical planning and patient counseling. Objective: To identify and analyze the per-operative predictors that may necessitate the conversion of laparoscopic to open cholecystectomy. Methods: This study was conducted in Surgical Unit 3 at Bahawal Victoria Hospital, Bahawalpur as a prospective observational study spanning over 6 months from September 2022 to February 2023. All patients who were booked for Laparoscopic cholecystectomy were included. The data of preoperative and perioperative factors were collected on a standard proforma. Operative findings which were analyzed and documented by the surgeon were then, compared to look for the factors that contribute to conversion of Laparoscopic cholecystectomy into open procedure. Results: Mean ± SD of age was 42.59 ± 13.14.  Regarding frequency of per-operative findings. It reveals that adhesions were found in 20 (22.7%) of the 88 procedures, difficult anatomy at Callot’s triangle was present in 12 (13.6%) cases, unmanageable bleeding occurred in 4 (4.5%) cases, and damage to nearby structures was observed in 6 (6.8%) procedures. The remaining procedures did not exhibit these issues. Conclusions: Our study has conclusively identified critical per-operative predictors for the conversion of laparoscopic cholecystectomy to an open procedure. These insights are instrumental for preoperative assessment and planning, potentially guiding clinical decisions to optimize patient care and surgical outcomes.