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01-06-2016 | ORIGINAL ARTICLE

Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted!

Authors: Johannes Spohnholz, Torsten Herzog, Johanna Munding, Orlin Belyaev, Waldemar Uhl, Chris Braumann, Ansgar Michael Chromik

Published in: Langenbeck's Archives of Surgery | Issue 4/2016

Abstract

Background

Although laparoscopic cholecystectomy is recommended as standard treatment for acute cholecystitis, in 10–30 % a conversion to open cholecystectomy is required. Among some surgeons, this is still perceived as a “complication.” The aim of our study was to define characteristics and outcome of patients with acute cholecystitis undergoing conversion cholecystectomy.

Methods

Over a 9-year period, 464 consecutive patients undergoing cholecystectomy for acute cholecystitis were analyzed for demographic, preoperative, intraoperative, histopathological, and laboratory findings and surgical outcome parameters.

Results

Patients with conversion cholecystectomy were characterized by younger age, lower American Society of Anesthesiologists (ASA) score, and less cardiac comorbidities compared to patients with primary open cholecystectomy. Severity of inflammation on the clinical and histopathological level was similar and comparable. Overall complication rate, mortality, and median hospital stay were significantly lower compared to those of primary open cholecystectomy group.

Conclusions

There are no disadvantages for patients undergoing conversion cholecystectomy compared to primary open cholecystectomy. The outcome is influenced by general condition and comorbidities rather than by the surgical approach. Underlying fear of conversion should not avoid a laparoscopic approach in patients with acute cholecystitis.

Gutt CN et al (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC Study, NCT00447304). Ann Surg 258(3):385–393CrossRefPubMed

Strasberg SM (2008) Clinical practice. Acute calculous cholecystitis. N Engl J Med 358(26):2804–2811CrossRefPubMed

Yokoe M et al (2012) New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci 19(5):578–585CrossRefPubMedPubMedCentral

Yokoe M et al (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 20(1):35–46CrossRefPubMed

Takada T et al (2013) TG13: updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20(1):1–7CrossRefPubMed

Gadacz TR, Talamini MA (1991) Traditional versus laparoscopic cholecystectomy. Am J Surg 161(3):336–338CrossRefPubMed

van der Steeg HJ et al (2011) Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital. Scand J Surg 100(3):169–173PubMed

Giger UF et al (2006) Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the swiss association of laparoscopic and thoracoscopic surgery database. J Am Coll Surg 203(5):723–728CrossRefPubMed

Wolf AS et al (2009) Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg 197(6):781–784CrossRefPubMed

10.

Zacks SL et al (2002) A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 97(2):334–340CrossRefPubMed

11.

Carbonell AM et al (2005) Do patient or hospital demographics predict cholecystectomy outcomes? A nationwide study of 93,578 patients. Surg Endosc 19(6):767–773CrossRefPubMed

12.

Alponat A et al (1997) Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 21(6):629–633CrossRefPubMed

13.

Visser BC, Parks RW, Garden OJ (2008) Open cholecystectomy in the laparoendoscopic era. Am J Surg 195(1):108–114CrossRefPubMed

14.

Peitzman AB, Watson GA, Marsh JW (2015) Acute cholecystitis: when to operate and how to do it safely. J Trauma Acute Care Surg 78(1):1–12CrossRefPubMed

15.

Licciardello A et al (2014) Preoperative risk factors for conversion from laparoscopic to open cholecystectomy. Eur Rev Med Pharmacol Sci 18(2 Suppl):60–68PubMed

16.

Madan AK et al (2002) How early is early laparoscopic treatment of acute cholecystitis? Am J Surg 183(3):232–236CrossRefPubMed

17.

Lo CM et al (1997) Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg 173(6):513–517CrossRefPubMed

18.

Goonawardena J, GunnarssonR, de Costa A Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors. Am J Surg

19.

Gourgiotis S et al (2007) Laparoscopic cholecystectomy: a safe approach for management of acute cholecystitis. JSLS 11(2):219–224PubMedPubMedCentral

20.

Tang B, Cuschieri A (2006) Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg 10(7):1081–1091CrossRefPubMed

21.

Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188(3):205–211CrossRefPubMed

22.

Araujo-Teixeira JP et al (1999) Laparoscopy or laparotomy in acute cholecystitis (200 cases). Comparison of the results and factors predictive of conversion. Chirurgie 124(5):529–535CrossRefPubMed

23.

Wevers KP, van Westreenen HL, Patijn GA (2013) Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion. Surg Laparosc Endosc Percutan Tech 23(2):163–166CrossRefPubMed

24.

Lengyel BI et al (2012) Laparoscopic cholecystectomy: what is the price of conversion? Surgery 152(2):173–178CrossRefPubMedPubMedCentral

25.

Litynski GS (1998) Erich Muhe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 2(4):341–346PubMedPubMedCentral

26.

McMahon AJ et al (2000) Impact of laparoscopic cholecystectomy: a population-based study. Lancet 356(9242):1632–1637CrossRefPubMed

27.

Shamim M et al (2009) Reasons of conversion of laparoscopic to open cholecystectomy in a tertiary care institution. J Pak Med Assoc 59(7):456–460PubMed

28.

Sain AH (1996) Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg 224(5):689–690CrossRefPubMedPubMedCentral

29.

Begos DG, Modlin IM (1994) Laparoscopic cholecystectomy: from gimmick to gold standard. J Clin Gastroenterol 19(4):325–330CrossRefPubMed

30.

Lengyel BI et al (2012) Laparoscopic cholecystectomy after a quarter century: why do we still convert? Surg Endosc 26(2):508–513CrossRefPubMedPubMedCentral

31.

Chandio A et al (2009) Factors influencing the successful completion of laparoscopic cholecystectomy. JSLS 13(4):581–586CrossRefPubMedPubMedCentral

32.

Shapiro AJ et al (1999) Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis. JSLS 3(2):127–130PubMedPubMedCentral

33.

Kum CK et al (1996) Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 20(1):43–48, discussion 48–9CrossRefPubMed

34.

Banz V et al (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 254(6):964–970CrossRefPubMed

Title: Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted!
Authors: Johannes Spohnholz
Torsten Herzog
Johanna Munding
Orlin Belyaev
Waldemar Uhl
Chris Braumann
Ansgar Michael Chromik
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1394-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted!

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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