Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5262  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (68 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed4902    
    Printed178    
    Emailed0    
    PDF Downloaded146    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


 


 
EXPERT'S COMMENTS
Year : 2005  |  Volume : 51  |  Issue : 1  |  Page : 21-22

Prediction of unsuccessful laparoscopic cholecystectomy


Department of Surgery, Angelholms Sjukhus, S-262 81 Angelholm, Sweden

Correspondence Address:
Lars-Erik Hammarstrom
Department of Surgery, Angelholms Sjukhus, S-262 81 Angelholm
Sweden
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions




How to cite this article:
Hammarstrom LE. Prediction of unsuccessful laparoscopic cholecystectomy. J Postgrad Med 2005;51:21-2

How to cite this URL:
Hammarstrom LE. Prediction of unsuccessful laparoscopic cholecystectomy. J Postgrad Med [serial online] 2005 [cited 2019 Nov 18];51:21-2. Available from: http://www.jpgmonline.com/text.asp?2005/51/1/21/14538


The quest for predicting the probability of conversion of laparoscopic cholecystectomy in unselected groups of patients with calculous gall bladder disease has been extensive. The outcome in the present study by Tayeb et al[1] lends support to acquired knowledge, that the major and independent risk factors for conversion are acute cholecystitis and advanced age.

Assessment of risk factors/constructing prognostic indices is merely an adjunct to qualified surgical judgment. Thus, Tayeb et al[1] prudently point out that conversion should be considered early if difficulties are encountered intraoperatively, and that open surgery should be scheduled in patients with additive risk factors.

Consequently, the prospect of preoperatively predicting conversion is important, in order to 'a priori' schedule open surgery or take appropriate measures if laparoscopy is scheduled. Intraoperative findings (adhesions, obscure anatomy) are left to the surgeon's experience and when dealt with qualified judgment and are less important predictors.[2] Male gender is frequently reported to be a risk factor for conversion,[2],[3],[4] a finding contradicted in the present study (23.3% males)[1] and elsewhere.[5]

Without concomitant cholecystitis, gall bladder wall thickness alone cannot be expected to be a strong predictor of conversion. Although associated with a conversion rate of 58% in this study, it was weak compared to the actual signs of inflammation (oedematous wall and pericholecystic fluid), which were associated with a conversion rate of about 90%. These findings highlight cholecystitis as a major predictor for conversion, but unfortunately, patients with acute cholecystitis have been studied less extensively, and results are inconsistent, with a potentially low impact on management.[2],[3],[5] Thus, this patient category deserves to be investigated further in prospective studies, in order to construct a refined prognostic index, and to improve the accuracy of the overall prediction of conversion of laparoscopic cholecystectomy.

Reportedly, superimposed bacterial infection (indicated by high C-reactive protein and leucocyte count, duration of inflammation, and positive bile cultures), which is known to increase with age, might be the most important cause of conversion in patients with acute cholecystitis.[2],[3],[4],[5],[6],[7]

In clinical practice, the important issue would be to define the probability of an event in terms of (arbitrary) 'high-risk'(>80%) or 'low-risk' (<10-15%). In this context, those figures for risk of conversion should lead to open and laparoscopic approach, respectively. An intermediate probability of conversion would imply that the best available expertise is engaged when laparoscopy is scheduled, and that it hardly matters whether the risk of conversion is estimated to 30% or 50%.

Moreover, in order to proceed by improving/refining models for prediction of conversion, discrete variables (for example ultrasonographic and physical findings) are less reliable and reproducible, and "cut-off" points for continuous variables might be useful but blunt, suggesting that the construction of prognostic indices from continuous variables should be investigated further, especially in patients with acute cholecystitis.

 
 :: References Top

1.Tayeb M, Raza SA, Khan MR, Azami R. Conversion from laparoscopic to open cholecystectomy: multivariate analysis of preoperative risk factors. J Postgrad Med 2005;51:xx-xx.  Back to cited text no. 1    
2.Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Elder S. Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 2000;14:755-60.  Back to cited text no. 2    
3.Merriam LT, Kanaan SA, Dawes LG, Angelo P, Prystowsky JB, Rege RV, et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 1999;126:680-6.  Back to cited text no. 3    
4.Hammarström LE, Mellander S, Rudström H. A prognostic index of unsuccessful laparoscopic cholecystectomy for acute calculous cholecystitis. Int J Surg Invest 2001;2:387-92.  Back to cited text no. 4    
5.Teixeira JP, Saraiva AC, Cabral AC, Barros H, Reis JR, Teixeira A. Conversion factors in laparoscopic cholecystectomy for acute cholecystitis. Hepatogastroenterology 2000;47:626-30.  Back to cited text no. 5  [PUBMED]  
6.Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparosc Endosc 1998;8:200-7.  Back to cited text no. 6  [PUBMED]  
7.Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993;217:233-6.   Back to cited text no. 7  [PUBMED]  



This article has been cited by
1 A comparison of the outcome between acute open and acute laparoscopic cholecystectomy
Hosseini, S.N., Mousavinasab, S.N., Rahmanpour, H., Vakili, M.M.
Iranian Red Crescent Medical Journal. 2008; 10(2): 84-88
[Pubmed]
2 Outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis
Hosseini, S.N., Mousavinasab, S.N., Rahmanpoor, H.
Journal of the College of Physicians and Surgeons Pakistan. 2007; 17(7): 406-409
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow