Factors influencing conversion and complications of elective laparoscopic cholecystectomy in a Nigerian Hospital

Adewale O Adisa, MBChB, FWACS, FMCS, DMAS, Olalekan Olaseinde, FWACS, Olusegun I Alatise, FWACS, FMCS, MSc, Oladejo Lawal, FMCS, FWACS. Obafemi Awolowo University

Objective: To determine factors that influence conversion to open surgery and occurrence of intra and postoperative complications following elective laparoscopic cholecystectomy.

Method: All patients undergoing elective laparoscopic cholecystectomy at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from January 2009 through September 2013 were prospectively evaluated. Socio-demographic and anthropometric data were obtained and occurrence of conversions, intraoperative and postoperative complications were documented.

Results: Seventy-two patients, including 60(83.3%) females and 12(16.7%) males with an age range 18-82 years (Mean 45.6yr) had elective laparoscopic cholecystectomy within the study period. Chronic calculous cholecystitis was the commonest indication (61 %), with acute inflammation in 11(%) patients. Gallbladder wall thickness was normal (=3mm) in 47(65.3%), thick (4-9mm) in 17(23.6%) and very thick (=10mm) in 8(11.1%) patients. Gallbladder mucocele was encountered in 9(%), gallbladder empyema in 4(%) and gangrenous gallbladder in 2(%) cases. Six (8.3%) procedures were converted to open laparotomy, bile duct injury occurred in 2(2.8%) and port site infections in 4(5.6%) cases. No mortality was recorded in this series. Conversion was significantly associated with gallbladder wall thickness and acute calculous cholecystitis.

Conclusion: Acute calculous cholecystitis and a thickened gallbladder wall may significantly influence conversion of laparoscopic cholecystectomy to open procedure and may serve as preoperative predictors.

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