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Timing of urgent laparoscopic cholecystectomy does not influence conversion rate
J S Knight1, S J Mercer, S S Somers
1Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
The British Journal of Surgery
|May 4, 2004
Summary
Urgent laparoscopic cholecystectomy for acute gallstone disease has a low conversion rate (12%) when performed by experienced surgeons. The timing of surgery does not impact conversion rates, challenging previous assumptions.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Acute gallstone disease management often involves urgent laparoscopic cholecystectomy.
- Existing literature suggests a potential increase in conversion rates with delays beyond 3-4 days.
- This study investigates the relationship between surgical timing and conversion rates.
Purpose of the Study:
- To assess the impact of surgical timing on conversion rates for laparoscopic cholecystectomy in acute gallstone disease.
- To evaluate the efficacy of a specialist-led protocol for urgent gallbladder surgery.
Main Methods:
- Prospective data collection over six months (March-August 2002).
- Analysis of 84 patients undergoing urgent laparoscopic cholecystectomy during their index admission.
- Comparison of conversion rates for procedures performed within and after 3 and 4 days of admission.
Main Results:
- Overall conversion rate was 12% (10 out of 84 patients).
- Conversion rates were similar for surgeries within 3 days (4/40) versus after 3 days (6/44).
- Conversion rates were also similar for surgeries within 4 days (5/46) versus after 4 days (5/38).
Conclusions:
- Urgent laparoscopic cholecystectomy can achieve low conversion rates (12%) under a specialist-led protocol with experienced surgeons.
- The timing of surgery for acute gallstone disease does not significantly affect the conversion rate.
- The study found no deaths and one common bile duct injury, indicating a safe procedure.