Factors Influencing Frequency of Conversion During Laparoscopic Cholecystectomy
The aim of the study was to evaluate factors influencing the frequency of conversion during laparoscopic cholecystectomy; to observe dynamic trends concerning frequency of classic versus laparoscopic cholecystectomies; and to evaluate correlations between the experience of a surgeon and conversion incidence.
Material and methods. A retrospective study was performed, reviewing the records of 3337 patients operated on for gallbladder stones from January 2000 to December 2005 in three hospitals in the Pomeranian Region of Poland: Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk; Department of Surgery, 110th Military Hospital in Elbląg and Department of Surgery, Hospital in Słupsk.
The main issues evaluated were: dynamic changes in frequency of laparoscopic versus classic cholecystectomies; frequency of conversions, reasons for conversion; correlation between experience of a surgeon and conversion incidence; and demographic data.
Results. Out of 3337 patients, there were 2390 (71.62%) females and 947 (28.3%) males. For these patients, 1493 procedures (45.2%) were performed as classical, 1804 (54.06%) as laparoscopic, and 176 (9.7%) as converted from laparoscopy to open procedure. Sex distribution in the laparoscopic group was 1352:452 (F:M 74.9%:25.05%) and in the converted group was 107:69 (60.8%:39.2%).
The main problems relating to conversion during laparoscopic cholecystectomy were: adhesions - 108 (61.36%), gall-bladder perforations - 8 (4.5%), tumors - 10 (5.6%), technical problems - 28 (15.9%), hemostasis problems - 11 (6.25%), unrecognizable anatomical structures - 24 (13.6%), complications of ‘e fundo’ cholecystectomy - 24 (13.6%) and equipment problems - 4 (2.27%).
It was also observed that SHO's and surgeons with greater experience are performing more conversions during laparoscopic procedures.
Conclusions. Laparoscopic cholecystectomy is a safe procedure recommended as a gold standard for gallbladder stone treatment. Frequency of this procedure is rising in centers in the Pomeranian region.
The highest incidence of conversions is associated with adhesions after previous open operations.
Consultants perform earlier conversion due to greater experience and better estimation of risk factors.
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