Cicero LA, Valdés FJA, Decanini MA, Golffier RC, Cicero LC, Cervantes CJ, Rojas RG

Language: Spanish
References: 17
Page: 66-73
PDF size: 167.21 Kb.

ABSTRACT

Laparoscopic cholecystectomy has been accepted as the treatment of choice for the surgical pathologies of the gallbladder. It is considered a basic laparoscopic procedure, nevertheless it has to be converted to an open procedure occasionally. Patients and methods: We studied 1,841 patients who underwent laparoscopic cholecytstectomy at the ABC Medical Center, from January 1, 1999 to December 31, 2003. We used the Medical Electronic File System. Results: There were 1,150 women (62.39%) and 691 men (37.56%) with a mean age of 49 years. Four hundred and eighty patients underwent emergency procedures (26.07%) and 1,316 were operated on electively (73.92%). There were 42 complications (2.28%), the most frequent were hemorrhage of the gallbladder bed and bleeding of a laparoscopic port. Fifty-one cases were converted to an open procedure (2.7%), only twelve of them due to a complication (23.52%). In the remaining 38 cases the conversion was due to the presence of adhesions and technical difficulties. The mean age in this group was 58 years. Forty patients underwent elective surgery (78.47%) and eleven underwent emergency procedures (21.56%). The mean hospital stay was 6 days for this group of patients and the average surgical time was 197 minutes. The body mass index in this group of patients was 26.72 kg/m2 (13.39 a 42.27 kg/m²). Fifty percent of these patients presented with acute cholecystitis, 30% chronic cholecystitis and the rest had associated conditions such as Mirizzi’s syndrome, choledocholithiasis, etc. The only variable related to an elevated conversion risk was the age (p = 0.01; OR = 1.30). The difference between the in-hospital stay (2.2 vs 6 days) and the difference in the surgical time were also statistically significant (p = 0.003 [OR = 1.11] and p = 0.000 [OR = 1.01]), respectively. Conclusions: The causes of conversion do not depend on the technical skills of the surgeon, in the majority of cases the conversion is due to the patient’s condition. There are no factors that can accurately predict the conversion to an open procedure.

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