Laparoscopic Cholecystectomy: Rate and Predictors for Conversion

Laparoscopy for diagnostic and operative purposes offers specific advantages to the patient. Apart from the aesthetic appeal, the shorter hospitalization, a more rapid return to normal activity than after traditional open surgery and decreased postoperative morbidity are particularly strong arguments for laparoscopic surgery. Currently, the most frequently performed laparoscopic upper abdominal operation is laparoscopic cholecystectomy. Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that obscure vision are discovered during about laparoscopic surgeries, forcing surgeons to switch to the standard cholecystectomy for safe removal of the gallbladder. Adhesions and gangrene, of course, can be quite serious, but converting to open surgery does not equate to a complication. One common complication of cholecystectomy is inadvertent injury to an anomalous bile duct known as duct of Luschka. It is non-problematic until the gall bladder is removed, and the tiny duct may be incompletely cauterized or remains unobserved, leading to biliary leak post operatively. The aim of this study is to determine the rate of conversion from laparoscopic to open cholecystectomy and to determine some factors to predict the conversion to open cholecystectomy which might help in properly selecting patients for Day Care ambulatory laparoscopic cholecystectomy, in our clinic. Methods: Laparoscopic cholecystectomy was attempted in 2419 patients, 79 (3, 26%) had to be converted to open cholecystectomy. Results: Acute cholecystitis was the commonest reason for conversion (71 patients, 89, 87%). These data confirms the safety of laparoscopic cholecystectomy. Identify a factor which predicts conversion to open cholecystectomy may be helpful in selecting patients for laparoscopic cholecystectomy. performed only by experienced surgeons and only on patients who have symptoms of gallstones [2]. In addition, the panel noted that the outcome of laparoscopic cholecystectomy is greatly influenced by the training, experience, skill, and judgment of the surgeon performing the procedure. Therefore, the panel recommended that strict guidelines be developed for training and granting credentials in laparoscopic surgery, determining competence, and monitoring quality. According to the panel, efforts should continue toward developing a noninvasive approach to gallstone treatment that will not only eliminate existing stones, but also prevent their formation or recurrence [3]. These skills include a shift from a three-dimensional operating field to a two-dimensional monitor display, judgment of altered depth perception and spatial relationships, distorted eye-hand coordination, adaption to the fulcrum effect, manipulation of long surgical instruments while adjusting for amplified tremor, diminished tactile feedback, and fewer degrees of freedom. To guarantee safe performance of laparoscopy, surgeons must be properly trained, and the procedures must be assessed thoroughly [4]. Furthermore, laparoscopic cholecystectomy may lead to less deterioration in postoperative pulmonary function, and lower morbidity and mortality rates. Cardiovascular status improved during laparoscopy. This suggests that a surgery induced sympathic stimulation was the main cause for improved cardiac function.