Study of open conversion in Laparoscopic Cholecystectomy

Background: Laparoscopic surgery has revolutionized the way it is performed for an increasing number of patients. In this study, we determined the various reasons for conversion of laparoscopic cholecystectomy in our setup. Material & Methods: This was a descriptive study, conducted at Ghulam Muhammad Mahar Medical College Hospital and Hira Medical Centre, Sukkur, from January 2006 to June 2010. The study included 1224 patients with symptomatic cholelithiasis, who underwent laparoscopic cholecystectomy. All patients were operated by experienced laparoscopic surgeons with experience of more than 300 Laparoscopic cholecystectomies. Cases that required conversion from laparoscopic to open surgery were analyzed and the factors responsible for such conversion were studied. Results: The mean age of patients was 45 years and male to female ratio 1:4. The mean operating time was 45 minutes and average hospital stay was 2 days. Out of 1224 patients, 8(0.65%) required open conversion. Factors responsible for open conversion were dense adhesions in 3(0.25%), fibrosed gall-bladder with cholecystoduodenal fistula in 1(0.081%), CBD injury 1(0.081%), Mirizzi’s syndrome 1(0.081%), and instrument failure as well as power breakdown with backup failure in 2(0.16%) conversions. Conclusion: Open conversion rate of laparoscopic cholecystectomy in this study was 0.65%. The commonest cause of conversion was dense adhesions around the gall-bladder. Preventable factors like instrument failure or power breakdown can be addressed by a reliable back up.