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Cholecystectomy, conversion and complications.

M H Thompson1, J R Benger

  • 1The Department of Surgery, Southmead Hospital, Bristol, United Kingdom.

HPB Surgery : a World Journal of Hepatic, Pancreatic and Biliary Surgery
|September 8, 2000
PubMed
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Laparoscopic cholecystectomy (gallbladder removal) shows no significant difference in complication rates compared to open surgery when analyzed on an intention-to-treat basis. Reducing conversion rates does not significantly impact patient outcomes.

Area of Science:

  • Surgical outcomes research
  • Minimally invasive surgery complications
  • Biliary tract surgery

Background:

  • Surgeons may hesitate to convert difficult laparoscopic cholecystectomies to open procedures due to perceived risks of laparotomy.
  • Limited data exists on the actual impact of conversion on patient complications.
  • This study addresses the gap in understanding conversion effects in cholecystectomy.

Purpose of the Study:

  • To quantify and compare complication rates associated with laparoscopic cholecystectomy versus open cholecystectomy.
  • To evaluate the influence of the conversion rate from laparoscopic to open surgery on patient outcomes.

Main Methods:

  • Prospective audit of 957 patients across three groups: open cholecystectomy (n=384), laparoscopic cholecystectomy with 5.8% conversion (n=412), and laparoscopic cholecystectomy with 1.3% conversion (n=161).

Related Experiment Videos

  • Complication rates were compared on an intention-to-treat basis.
  • Experienced surgeons scored complication severity, and a composite score was calculated for group comparisons.

    • Main Results:

    • Open cholecystectomy had a 6% post-operative complication rate.
    • Laparoscopic cholecystectomy showed initial rates of 3.1% (5.8% conversion) and 3.1% (1.3% conversion) when analyzed intention-to-treat, not significantly different from open surgery.
    • A statistically significant reduction in conversion rate was observed from 5.8% to 1.3% between the two laparoscopic groups.

    Conclusions:

    • Laparoscopic cholecystectomy offers no significant advantage over open surgery regarding complication frequency or severity when assessed on an intention-to-treat basis.
    • Reducing the conversion rate in laparoscopic cholecystectomy does not significantly alter complication rates.
    • Surgeons should not fear converting to open surgery during difficult laparoscopic procedures due to post-operative concerns.