| Article Access Statistics | | | Viewed | 5747 | | | Printed | 184 | | | Emailed | 0 | | | PDF Downloaded | 141 | | | Comments | [Add] | | |
|
Click on image for details.
|
|
| EXPERT'S COMMENTS |
|
|
|
| Year : 2005 | Volume
: 51
| Issue : 1 | Page : 21 |
Conversion to an open approach during video-laparocholecystectomy
Valentino Tiziano Pio Pio
University of Foggia, Department of Surgical Sciences, Division of General Surgery, Polyclinic of Foggia, Foggia, Italy
Correspondence Address:
Valentino Tiziano Pio Pio
University of Foggia, Department of Surgical Sciences, Division of General Surgery, Polyclinic of Foggia, Foggia
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Pio VT. Conversion to an open approach during video-laparocholecystectomy. J Postgrad Med 2005;51:21 |
The conversions during video-laparocholecystectomy are due to two reasons: first, the anatomic variations and the intraoperative complications, that are absolutely unpredictable and accidental; second, the acute cholecystitis, with clinical (right upper abdominal quadrant pain with positive Murphy's sign and fever) and instrumental evidence (US signs of increase of the thickness of the gallbladder wall, presence of pericholecystic fluid material),[1] male gender,[2] hepatic cirrhosis,[3] portal hypertension and obesity, because of the greater adiposity of the hepato-duodenal ligament and so a greater difficulty in the recognition of the structures in the Calot's triangle.[4],[5]
All this data are evident in the preoperative phase and are in part emendable. An important role is played by the first surgeon's formation, ability and care, because the management of an intraoperative accident, the recognition of an anatomic anomaly or the execution of a difficult cholecystectomy can be evaluated and treated in different way, sometimes even without conversion to an open procedure.[6]
The development of a model that can show, surely, in the preoperative phase, the exact probability of conversion of a video-laparocholecystectomy to an open approach, is not a practicable idea, because there are a great number of variables, that are not all predictable and manageable; instead, it is right to maintain that must be considered some factors in the presence of which the generic probability of conversion can increase; this must be done with the aim of a good and precise conversation with the patient.
In presence of preoperative predictive factors of difficulty of the laparoscopic cholecystectomy, the surgeon's experience will give the probability of the risk of conversion.
In conclusion we can propose two considerations: the first of ethical order and the second technical.
The decision of converting the intervention to an open traditional approach must be never considered a defeat by the surgeon. The laparoscopic approach is only a technical modality of executing the same intervention.
The decision of changing approach in order to improve the surgical performance does not damage the therapeutic program and has the aim to give the patient the best treatment.
From a technical point of view, we recommend the partially antegrade laparoscopic cholecystectomy, that we execute as a routine.
| :: References | |  |
| 1. | Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS 2002;6:59-63.  [PUBMED] |
| 2. | Russell JC, Walsh SJ, Reed-Fourquet L, Mattie A, Lynch J. Symptomatic cholelithiasis: a different disease in men? Connecticut Laparoscopic Cholecystectomy Registry. Ann Surg 1998;227:195-200. |
| 3. | Cucinotta E, Lazzara S, Melita G. Laparoscopic cholecystectomy in cirrhotic patients. Surg Endosc 2003;17:1958-60. [PUBMED] [FULLTEXT] |
| 4. | Sinha R, Sharma N. Acute cholecystitis and laparoscopic cholecystectomy. JSLS 2002;6:65-8. [PUBMED] |
| 5. | Shapiro AJ, Costello C, Harkabus M, North JH Jr. Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis. JSLS 1999;3:127-30. [PUBMED] |
| 6. | Neri V, Ambrosi A, Di Lauro G, Fersini A, Valentino TP. Difficult cholecystectomies: validity of the laparoscopic approach. JSLS 2003;7:329-33. [PUBMED] |
|
