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BMC Surgery
Published in: BMC Surgery 1/2023

Open Access 01-12-2023 | Choledocholithiasis | Research

A nomogram to predict conversion of laparoscopic surgery to laparotomy for Choledocholithiasis

Authors: Yitao Zheng, Haoyang Lv, Zhuoqun Lin, Hongqi Shi, Xiaming Huang

Published in: BMC Surgery | Issue 1/2023

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Abstract

Background

Laparoscopic surgery is effective for treating common bile duct (CBD) stones. However, it has high requirements for surgeons and the risk of conversion to laparotomy cannot be ignored. However, when conditions during surgery are not favorable, persisting with laparoscopic procedures blindly can lead to serious complications. Our study aimed to establish a nomogram model for predicting conversion of laparoscopic to laparotomy for choledocholithiasis.

Materials and methods

A total of 867 patients who were diagnosed with choledocholithiasis and underwent laparoscopic surgery were randomly divided into a training group (70%, n = 607) and a validation group (30%, n = 260). A nomogram was constructed based on the results of logistic regression analysis. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to assess the predictive performance of the nomogram.

Results

Previous upper abdominal surgery, maximum diameter of stone ≥12 mm, medial wall of the duodenum stone, thickening of the gallbladder wall, thickening of CBD wall, stone size/CBD size ≥0.75, and simultaneous laparoscopic hepatectomy were included in the nomogram. The AUC values were 0.813 (95% CI: 0.766–0.861) and 0.804 (95% CI: 0.737–0.871) in the training and validation groups, respectively. The calibration curve showed excellent consistency between the nomogram predictions and actual observations. DCA showed a positive net benefit for the nomogram.

Conclusions

We constructed a nomogram with a good ability to predict conversion to open surgery in laparoscopic surgery for choledocholithiasis, which can help surgeons to make a reasonable operation plan before surgery and timely convert to laparotomy during operation to reduce potential harm to the patient.
Appendix
Available only for authorised users
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Metadata
Title
A nomogram to predict conversion of laparoscopic surgery to laparotomy for Choledocholithiasis
Authors
Yitao Zheng
Haoyang Lv
Zhuoqun Lin
Hongqi Shi
Xiaming Huang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2023
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-023-02275-1

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