Conversions during laparoscopic surgery: a qestionnaire based review according new conversion categories in Hungary

Istvan Gal, PhD, Zoltan Szabo, PhD, Miklos Czobel, MD, Gyorgy Weber, PhD. Robert Karoly Privat Hospital, Budapest Hungary, M.O.E.T. institute, San Francisco, CA, USA,, Department of Surgical Research and Technique Semmelweis Medical School of .Budapest, Hungary.

The laparoscopic surgical procedures were introduced in Hungary in 1990.Since then, more than 180.000 operations have been performed.To date , the frequency of conversion from laparoscopic to open surgery for various procedures has not been comprehensively analyzed, so that neither in number and percentage of conversions nor the categories to which change is not well understood. We devised a questionnaire using new categories for conversions proposed by B. Lengyel et al.( Surg Endosc 2012; 26:508-13).This questionnaire was sent to 25 Surgical Units in Hungary and involved collecting data on the number of different laparoscopic operations performed in 2012, the rate  and categories of conversions using these new categories.

These categories include:1:inability to access peritoneal space 2A:lack of effort to achieve appropriate exposure, 2B: lack of exposure despite the effort to dissect, 3:emergent conversion

In the database 7,822 patients were enrolled, including 5,914 laparoscopic cholecystectomies, 1, 113 laparoscopic appendectomies, 563 inguinal hernioplasties,51 laparoscopic abdominal wall reconstructions,47 laparoscopic antirefflux procedures,122 laparoscopic colorectal procedures and 12 laparoscopic liver resections. The total rate of conversions and the categories are as follows: laparoscopic cholecystectomy:5%( 1: 3.2 % 2A:21.6 %, 2B:62.3 %, 3:12.9%), laparoscopic appendectomy: 6.8% ( 1:0%, 2A:17.04%, 2B:83.5 %, 3:4.3%), laparoscopic inguinal hernioplsty:2% ( 1: 0%, 2A:77.9%, 2B:0%, 3:22.1%), laparoscopic abdominal wall reconstruction: 0%,laparoscopic antireflux procedure: 5.4%( 1: 0%, 2A: 0%, 2B: 0% 3: 100%), laparoscopic colorectal: 4.8%( 1:0%, 2A:50%, 2B:50%, 3:0%), laparoscopic liver resection:0%

Conclusions: The rate of conversion during laparoscopic surgery is not uniform across procedures and it is important for patient counseling.The frequency and the category of conversion is dynamic and likely related the cumulative experience of the surgeon.   



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