|RMJ. 2017; 42(4): 541-545
Factors influencing the outcome of laparoscopic cholecystectomy at Hospital Tuanku Jaafar Seremban, Malaysia.
Tan Shi Hun, Ismail Abdul Sattar Burud, Lau Shi Lin, Annete Hove, Pooja Roy, Dorcas Selwyn, Mahadevan Deva Tata.
Objectives: To identify pre-operative factors that predisposes to conversion of laparoscopic cholecystectomy.
Methodology: Patients with symptomatic cholelithiasis from a tertiary hospital were selected for this cross-sectional study. The patient data was obtained from the hospital online database. Patients aged ≥ 18 years with clinical diagnosis of symptomatic cholelithiasis who underwent laparoscopic cholecystectomy from January 2013 to December 2014 were included in the study. Those who underwent planned open cholecystectomy, patients with gallbladder polyps, acalculous cholecystitis and history of previous laparotomy were excluded from the study. Data were analyzed using chi-square test, Fishers exact test and logistic regression.
Results: Two hundred patients fulfilled the inclusion criteria. Conversion to open cholecystectomy was seen in 28 patients (14%). Patients with acute cholecystitis were 3.4 times more likely and males were 2.5 times more likely to undergo conversion. The likelihood of conversion increased by 0.9 times for each year of increase in age. Patients with diabetes mellitus were 3.8 times more likely to undergo conversion. Hypertension was also a significant factor contributing to a conversion. After a logistic regression analysis, only three factors remained statistically independently significant: diabetes mellitus (95% CI: 0.1 to 0.6), acute cholecystitis (95% CI: 0.1 to 0.7) and male gender (95%CI: 0.7 to 0.9).
Conclusions: Decision to convert laparoscopic cholecystectomy to open should be taken earlier in a male patient with diabetes mellitus, acute cholecystitis and advancing age.
Key words: Cholelithiasis
Conversion to an open surgical procedure,