Tehran University Medical Journal (Sep 2000)
The indications and contraindications of laparoscopic cholecystectomy and its conversion to open rate in Imam Hospital, 1372-77
Abstract
Since its introduction in 1988, laparoscopic cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1) Recurrent biliary colic (88.4%), 2) Non-specific manifestations of gallstone (5.8%) and 3) Asymptomatic gallstone (1.7%). Contraindications for LC are: 1) Acute cholecystitis 2) CBD stone and/or dilatation, 3) Gallbladder cancer, 4) Intra-abdominal malignancies, 5) The need for other elective abdominal operation, 6) History of upper abdominal, laparatomy, 7) Sepsis, 8) Ileus, 9) Peritonitis, 10) Pancreatitis and 11) Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision making is based on patient's general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: Severe adhesions, technical and enforced. There was no death after LC.
