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

BACKGROUND:Cholecystectomy is now one of the most commonly performed surgical procedures because theincidence 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 usingSPSSversion25, andlogisticregressiontodetermine the significant predictors ofconversion.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 outof 112 LCs 19.6%, primarilydueto difficult anatomy45.5%, risk of BDI31.8%, 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 ofthe presumably risky ones will help decrease the rates of the conversion and the possible adverse consequences.