Difficult laparoscopic cholecystectomies. Is conversion a sensible option?

Objective: To assess the overall impact of conversion of laparoscopic cholecystectomy to open cholecystectomy.

Methods: The observational descriptive study was conducted at Liaquat University Hospital, Jamshoro, Pakistan, and various private hospitals in the same town by the same surgeon from June 2011 to June 2013. All patients over 20 years of age and of either gender with symptomatic gallstone disease admitted and operated by laparoscopic technique were included. After initial work-up, laparoscopic cholecystectomy was performed by the conventional four-port technique. The variables studied included demographic details, duration of operation, operative complications, and incidence of conversion to open operation, post-operative complications and length of hospital stay. Data was analysed using SPSS 20.

Results: Of the 936 patients, 839(89.63%) were females and 97(10.36%) were males with an overall mean age of 39.88±8.66 (range: 29-65 years). Of the total, 108(11.53%) patients presented with a solitary gallstone; the remaining 828(88.46%) had multiple gall stones. Besides, 297(15.34%) had complicated gall stone disease. Tenderness in the right hypochondrium was observed in 897(95.83%) patients, while tenderness with palpable, tender gallbladder with fever and leucocytosis in 39(4.1%). Overall, 120(12.82%) patients presented with co-morbidities comprising diabetes mellitus in 43(4.59%), hypertension in 11(1.17%), ischaemic heart disease in 36(3.84%) and chronic obstructive pulmonary disease in 30(3.20%) patients. Further, 33(3.52%) patients were shifted from laparoscopic dissection to open cholecystectomy.

Conclusions: A low threshold for conversion to open cholecystectomy can save the life of patients as continued dissection in difficult situation can lead to life-threatening complications.