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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 October;12(5):319-26
Laparotomic conversion during videolaparoscopic cholecystectomy
LAP Club, Gruppo Collaborativo Italiano per lo sviluppo della Chirurgia Videolaparoscopica e delle Tecniche Mininvasive
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Background. This study is a multicentric retrospective analysis of causes of conversion to laparotomy during videolaparoscopic cholecystectomy.
Methods. The study was conducted by a questionnaire mailed to all surgeons working in Naples and its neighbouring area with an experience of >100 cholecystectomies performed with laparoscopic access.
Results. 407 (3.2%) patients out of 12,718 videolaparoscopic cholecystectomies were converted to laparotomy (February 1990-November 1997). Causes of conversion not related to laparoscopic cholecystectomy have been 27 (6.6%): diagnostic failure (n=7; 25.9%), equipment failure (n=9; 33.3%), pneumoperitoneum complications (n=1; 40.8%). Mortality in this group (n=1; 0.3%) was due to Veress needle vascular injury. Causes of conversion related to laparoscopic cholecystectomy have been 380 (93.4%): adhesions (n=180; 47.6%), not dissectable Calot triangle (n=76; 20%), vascular and anathomical variations (n=10; 2.5%), advanced acute and chronic inflammation (n=25; 6.7%), common bile duct stones (n=19; 5%), gallbladder cancer (n=11; 2.8%), complications during surgical dissection (biliary: 23.6%, vascular: 36; 9.4%). Mortality was absent. Laparoscopic time before conversion has been 30±10 minutes (range 7-150). Laparotomy was complicated in 38 (9.3%) patients, 4 of whom (10.5%) required subsequent laparotomy.
Conclusion. The results of this study, orally presented to partecipating surgeons, gave an excellent opportunity for discussion, confirming the good results of laparoscopic cholecystectomy, and underlined that conversion to laparotomy is an operation with a higher morbidity risk in comparison to open cholecystectomy