FACTORS INFLUENCING CONVERSION FROM LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY DUE TO RISK OF BILE DUCT INJURY: AN ANALYTICAL STUDY

.JPUMHS;2024:14:03,103-111.http://doi.org/10.46536/jpumhs/2024/14.03.541

Abstract

ABSTRACT
BACKGROUND: Cholecystectomy is now one of the most commonly performed surgical procedures because the
incidence of gallbladder disease has risen dramatically. The latter that is, LC is preferred than OC since it is less invasive,
causes less pain and has shorter hospital stay. However, LC has been attributes to pose a threat to the BDI and as a result
requires conversion to OC and which in the process prolongs the operating time, hospital stay and consequently adds more
morbidity. OBJECTIVE: This study aims to identify and analyze factors influencing the conversion from laparoscopic
cholecystectomy to open cholecystectomy due to the risk of bile duct injury. MATERIALS AND METHODS:This was a
six months prospective observational study conducted on surgical units I, II, III of Peoples Medical College Hospital,
Nawabshah. We included CHC in a total of 132 patients undergoing elective or emergency cholecystectomy who had no
previous upper abdominal surgery, liver or bile duct disease not attributable to gallbladder disease, and impaired consent.
Data collection included baseline demographic data, clinical presentation, imaging data, intraoperative type of procedure,
complications, conversion reasons, and a postoperative complications, recovery outcome data. We performed statistical
analysis using SPSS version 25, and logistic regression to determine the significant predictors of conversion. RESULTS: Of
the 132 patients mean age 45.6 ± 12.3 years, 56.1% were female. Comorbidities included hypertension 24.2% and diabetes
20.5%. Abdominal pain was the most common preoperative symptom 72%. Conversion from LC to OC occurred in 22 out
of 112 LCs 19.6%, primarily due to difficult anatomy 45.5%, risk of BDI 31.8%, severe inflammation/adhesions 18.2%, and
intraoperative bleeding 4.5%. Logistic regression analysis revealed that age, comorbidities especially hypertension, difficult
anatomy, and abnormal preoperative imaging were significant predictors of conversion p<0.05, while gender was not.
CONCLUSION: This study has shown that challenging anatomic features and patient-specific factors like age and
comorbidities are valuable predictive factors for conversion from LC to OC because of BDI concerns. This study suggests
that enhanced preoperative evaluation of the patients and isolation of the presumably risky ones will help decrease the rates
of the conversion and the possible adverse consequences.