The president of Jabir ibn Hayyan medical university has published a research in an American journal
"Predictive factors for conversion of laparoscopic cholecystectomy"
Pro.Dr. Ali Mahmood AL-shammari , The president of Jabir ibn Hayyan medical university, has published a research in the International New Research Journal in Chicago, Illinois American state .
Previous studies evaluating predictive factors for conversion from laparoscopic to open cholecystectomy had drawn conflicting conclusions. We evaluated objective preoperative variables to identify accurate, accessible risk factors to predict conversion.
Patients and Methods:
A prospective evaluation was performed on (409) laparoscopic cholecystectomy patients at AL Sadur medical teaching hospital in AL Najaf Alashraf during the period from 1/3/2012 to 31/12/2012. thirteen characteristics were subjected to bivariate and logistic regression analysis to identify parameters that independently predict conversion to open cholecystectomy. including patient, laboratory, sonographic and surgeon factors. Exclusion criteria includes: patients with pancretitis, portal hypertension, gallbladder tumor and incomplete information with respect to anthropometry, laboratory investigations, and ultrasound findings. All our patients have elective laproscopic cholecystectomy. No subjective variables were included in an effort to improve the predictive value of our results. A model was created based on this analysis.
Laparoscopic cholecystectomy was performed on 409 patients for benign gallbladder disease and fifteen patients (3.7%) required conversion to open cholecystectomy. Conversion was required more often in patients with previous upper abdominal operation (28.6%, p<0,001) when compared with lower abdominal operation(2.9%, p=0,652)and no previous abdominal surgery (3.2%) Conversion rate was (26.7%, p<0.001) patients with increased GB wall thickness by ultrasound(>3mm) compared with 2.8% for patients with normal wall thickening.Bivariate analysis also identified elevated white blood cell count,raised serum alkaline phosphatase, ultrasound finding of pericholecystic fluid, empyma and surgeon with less experience as significant independent predictors of conversion,These factors were also associated with the pathologic diagnosis of acute cholecystitis. The risk for conversion will increase if more than one predictive factor are present.
Previous upper abdominal surgery, increased WBC(>11cell/mm3), increased serum alkaline phosphatase (>140 IU),thickened gallbladder wall(>3mm),presence of pericholecystic fluid and surgeon experience were significantly associated with increase conversion rate Although not significant factors,the age, gender, diabetes and GB stone size were found to be associated with increased risk for conversion to open cholecystectomy.