LAPAROSCOPIC CHOLECYSTECTOMY;

Per-operative factors responsible for difficulty in performance and conversion

Abstract

Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performing
laparoscopic cholecystectomy and lead to conversion. Study Design: Prospective analysis study. Place and Duration of study: This
study was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011
to July 2012. Methodology: This study consisted of one hundred & forty six patients with gallstone disease. All patients had full clinical
examination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly.
Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and for
assessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was not
attempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acute
pancreatitis, obstructive jaundice and unfit patients for general anesthesia. Results: Out of 146 patients included in this study 133 were
female (91%) and 13 male (9%); with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings were
adhesions in calot's triangle 24(16.43%) cases, severe & tight adhesions around gallbladder and calot's triangle 21(14.38%) cases,
obscured anatomy in calot's triangle 17(11.64%) cases, intrahepatic gallbladder 11(7.53%) cases, adhesions around gallbladder
26(17.80%) cases, empyema 13(8.90%) cases, mucocele 9(6.16%) and anatomical variation 14(9.58%) cases. We observed out of 21
patients who had Severe & tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopic
cholecystectomy in 11(52.38%) cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variation
also lead to performing difficult laparoscopic cholecystectomy in 6(35.29%) and 5(35.71%) cases respectively. Four (2.73%) cases out
of 146 had to be converted to the open cholecystectomy procedure. Conclusions: We conclude our study revealed that various
peroperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot's
triangle, severe & tight adhesions around gallbladder and obscured anatomy in calot's triangle.