Leslie S Anewenah, MD1, Mohammed Asif, MD1, Kristin Faschan, MD1, Urhum Khaliq2, Joseph Glowacki2, John Fobia, MD1, Leon Clarke, MD2. 1Mercy Catholic Medical Center, 2Philadelphia College of Osteopathic Medicine
Background and Objective: Since its introduction in the 1990s, Laparoscopic Cholecystectomy (LC) quickly emerged has the gold standard for treating gallbladder pathology (GP). The Open Cholecystectomy (OP) modality is, however, still well and alive. This is because some patients have contraindications to pneumoperitoneum and hence not amenable to LC. It is also sometimes necessary to convert from LC to OP (LCOP). The purpose of this study is to determine factors that are predictive of conversion from LC to OP.
Methods: This is a retrospective review of patients who under LC at our institution from June of 2012 to May 2016. Institutional review board approval was petitioned for and obtained. Data analyzed include gender, age, American Society of Anesthesiologist score (ASA), body mass index (BMI), comorbidities, procedure time, length of stay (LOS), reason for conversion, comorbidities and complications within 30 days of surgery. Independent T and Chi-square tests were performed using IBM® SPSS® 24 software.
Results: A total of 878 patients underwent LC. Median age was 47 years old (18 to 95). Females consisted of 667 (76%) of the patients. LC converted to open was observed in 40 (4.5%) patients. The reasons for conversion included: inability to identify the biliary structures 3 (8%), injury to biliary structures 3 (8%), adhesions 20 (50%) and other 14 (35%). Gender did not play a role in conversion to OP (p = 0.60). Average BMI of LCOP was 34 kg\m2 compared to 33 kg\m2 for patients who did not need conversion to OP (p=0.14). The following clinical factors increased the likelihood of LCOP: history of abdominal surgery (p = 0.019), diabetes mellitus (0.002), chronic kidney disease (p = 0.023), acute myocardium infarction (p = 0.038) and acute pancreatitis (p = 0.036). Chronic obstructive pulmonary disease (p = 0.266), anti-platelet or anticoagulation use (p = 0.526) and chronic hepatitis (p = 0.732) had no bearing on the tendency to LCOP. LCOP (32.5%) had more complications relative to patients who did not need conversion (14.6%) (p = 0.004).
Conclusion: Conversion to OP is an operative judgment that most general surgeons will have to make during their lifetime. The above predictors serve as a guideline to making such a judgment when performing LC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80619
Program Number: P650
Presentation Session: Poster (Non CME)
Presentation Type: Poster
