Journal of Islamic International Medical College (Jan 2024)
Difficult Laparoscopic Cholecystectomy and Its Conversion to Open Cholecystectomy Using Intra-Operative Scoring System
Abstract
Objective: To determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy using proposed intra-operative scoring system and to check the validity of the scoring system. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Surgery, Federal Government. Polyclinic Hospital (FGPC) Islamabad from 1 February 2019 to 31 July, 2019. Materials and Methods: This study enrolled 197 patients of either gender with age ranging between 20-60 years planned for laparoscopic cholecystectomy (LC). All the recruits were assessed intraoperatively using proposed objective intraoperative scoring-system for difficult LC. The conversion rate of LC to open cholecystectomy was recorded in correlation with demographic data and co-morbidities. Data was entered and analyzed using SPSS version 25.0. Results: Out of 197 enrolled patients, 64% were females. The mean age of study population was 42.7 ± 12.1 years. Forty six percent (46%) patients had co-morbidities with fifty-nine (n=59) being diagnosed as hypertensive and thirty-two (n=32) as diabetic. A total of 8.1% (n=16/197) patients underwent conversion to open cholecystectomy. The overall mean objective intra-operative score was 3.6 ± 1.73; which was significantly higher in patients who underwent conversion to open cholecystectomy compared to those who did not undergo conversion (7.19 ± 0.83 vs 3.28 ± 1.39; p-value = 0.001). Conversion rate was significantly more in the patients who were above 40 years, hypertensive, and diabetic. (p<0.05 in all cases). Conclusion: The intra-operative scoring system can be used as a valuable predictor of difficult LC and conversion to open surgery to improve clinical outcome for the patients indicated for LC.
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