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Effectiveness and predictors of conversion in mini-laparotomy cholecystectomy in developing country: a cohort
Adeodatus Yuda Handaya1, Joshua Andrew2, Ahmad Shafa Hanif2
1Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia. yudahandaya@ugm.ac.id.
Background:
Mini laparotomy cholecystectomy (MLC) is an alternative surgical procedure in conditions where laparoscopic cholecystectomy (LC) is not feasible. MLC is a simpler and easier technique compared to LC. MLC involves smaller skin incision, low morbidity rate, and early return to oral diet. MLC has the potential to be the preferred surgical technique in developing countries due to its low cost and availability.
Method:
A cohort retrospective study was performed on 44 patients who underwent mini laparotomy cholecystectomy due to ineligibility for LC. Patients were documented for successful mini laparotomy or conversion to laparotomy cholecystectomy. There are pre-operative aspects recorded and analyzed to formulate predictor factors for conversion surgery, as well as intra-operative and post-operative aspects. Patients also filled evaluation questionnaire based on Likert Scale about their satisfaction towards result of MLC.
Result:
MLC is performed in 31 (70.5%) patients while 13 (29.5%) patients underwent conversion to open cholecystectomy. There were no complications nor mortalities observed during and after the surgery. Greater BMI, higher leucocyte count, higher bilirubin level, increasing severity of adhesion, and chronic cholecystitis were found to be statistically significant (p < 0.05) in the conversion surgery group. MLC also resulted in shorter post-operative hospitalization compared to conversion surgery. Patients showed great satisfaction towards the cosmetic aspect and recovery period after MLC procedure.
Conclusion:
MLC is an effective surgery procedure for cholelithiasis and can be safely performed in patients with complication such as cholecystitis and gallbladder adhesion although these conditions increase the risk of conversion surgery.
