Factors influencing Complications and Conversion rates following Laparoscopic Cholecystectomy in Acute Cholecystitis
AbstractBackground: Laparoscopic cholecystectomy in acute cholecystitis is associated with a relatively high rate of conversion as well as complications. The aim of this study was to analyze prospectively various pre-operative and per-operative factors influencing the complications and conversion rate.
Methods: A total of 60 patients (45 females and 15 males) undergoing laparoscopic cholecystectomy for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their significance.
Results: Out of 60 patients, 10 patients (16.67%) were converted. Age > 65 years (p=0.005), body mass index >30 kg/m2 (p= 0.01), previous attack of acute cholecystitis (p=0.02), clinically palpable lump right hypochondrium (p= 0.001), time of surgery > 48 hours from admission (p= 0.002), time of surgery > 96 hours from symptom onset (p= 0.005),
short inflamed cystic duct (p= 0.01) and empyema gallbladder (p= 0.01) were significantly associated with conversion. 9 patients had major intra-operative complications (cystic duct avulsion = 3 patients, liver bed bleed = 3 patients, cystic artery bleed = 2 patients and duodenal injury = 1 patients) and 3 patients had post-operative complications( bile leak = 3
patients). Body mass index > 30 kg/m2 (p= 0.01), previous attack of acute cholecystitis (p=0.01), clinically palpable lump right hypochondrium ( p= 0.01), impacted stone at gallbladder neck (p= 0.007) and empyema gallbladder (p= 0.04) were associated with higher complication rates.
Conclusion: Laparoscopic cholecystectomy can be performed safely for acute cholecystitis, with acceptable low conversion and complication rates in selected cases. However, larger study groups will enable us to evaluate these predictors of conversions and complications more accurately.