Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: An Experience at Mymensingh Medical College Hospital.

Abstract

Laparoscopic cholecystectomy is the standard procedure for symptomatic gallstone disease; however, conversion to open cholecystectomy remains necessary in selected cases to ensure patient safety. This study assessed the frequency, intraoperative causes and selected operative factors related to conversion from laparoscopic to open cholecystectomy at Mymensingh Medical College Hospital, Bangladesh. This descriptive observational study was conducted from April to September 2018 among 73 patients aged more than 20 years undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Data were collected prospectively using a pretested structured questionnaire from patients, hospital records, direct intraoperative observation and operative notes. Associations between selected variables and conversion were assessed using Fisher's exact test, with p<0.05 considered statistically significant. The mean age of the patients was 43.6±12.9 years and 61 patients, 83.56%, were female. Conversion to open cholecystectomy was required in 7 patients, 9.59%. Dense adhesions and hemorrhage were the leading causes of conversion, each occurring in 2 patients, 2.74% of the total study population. Severe hemorrhage, 28.6% vs. 0.0%, p<0.05 and dense adhesions, 28.6% vs. 0.0%, p<0.05, were significantly associated with conversion. Bile duct injury, gallbladder mass and empyema of the gallbladder were less frequent causes of conversion and did not show statistically significant association. Conversion from laparoscopic to open cholecystectomy was required in approximately one in ten patients. Dense adhesions and significant hemorrhage were the principal conversion-related intraoperative factors in this local tertiary hospital setting. These findings provide baseline institutional data for future larger studies on difficult laparoscopic cholecystectomy, conversion risk assessment and operative preparedness.