Volume 8, Issue 4, August 2020, Page: 118-122
Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate
Deepak Verma, Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
Nemi Chand, Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
Sarthak Sharma, Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
Mahesh Malani, Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
Parul Yadav, Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
Received: Apr. 26, 2020;       Accepted: Jun. 19, 2020;       Published: Jul. 4, 2020
DOI: 10.11648/j.js.20200804.14      View  64      Downloads  35
Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.
Cholelithiasis, Cholecystectomy, Difficult Laparoscopic Cholecystectomy, Conversion to Open Cholecystectomy
To cite this article
Deepak Verma, Nemi Chand, Sarthak Sharma, Mahesh Malani, Parul Yadav, Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate, Journal of Surgery. Vol. 8, No. 4, 2020, pp. 118-122. doi: 10.11648/j.js.20200804.14
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Polychronidis A, Laftsidis P, Bounovas A et al (2008) Twenty years of Laparoscopic Cholecystectomy: Philippe Mouret, March 17, 1987, JSLS 12: 109-111.
McMahon AJ, Fischbacher CM, Frama SH et al (2008) Impact of Laparoscopic Cholecystectomy: a population based study. Lancet 356: 1632-1637.
Ercan M, Bostanci EB, Teke Z et al (2010) Predictive factors for conversion to open surgery in patients undergoing elective Laparoscopic Cholecystectomy. J Laparoendosc Adv Sur Tech 20, 427-434.
Lajan J, Parilla P, Rables R et al (1998) Laparoscopic Cholecystectomy v/s open cholecystectomyin the Treatment of Acute Cholecystitis. Arch Surg 133 (2), 173-5.
Randhawa JS, Pujahari AK (2009) Preoperative prediction of difficult laparoscopic cholecystectomy: a scoring method. Indian J Surg (July-August) 71: 198-201.
Tong B, Cuschieri A (2006) Conversion during Laparoscopic Cholecystectomy: rosk factors and effects on patient outcome. J Gastrointest Surg 10 (7): 1081-1091.
Lam CM, Murray PE, Cuscheri A (1996) Increased cholecystectomy rate after the introduction of Laparoscopic Cholecystectomy in Scotland Gut 38: 282-284.
Nidoni R, Udachan TV, Sasnur P et al (2015) Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment J Clin Diagn Res 9 (12): PC09-PC12.
Kanaan SA, Murayama KM, Merriam LT et al (2002) Risk factors for conversion to laparoscopic to open cholecystectomy J Surg Res Jul; 106: 20-24.
Joshi MR, Bohara TO, Rupakheti S et al (2015) Preoperative prediction of difficult laparoscopic cholecystectomy J Nepal Med Assoc 53 (200): 221-226.
Hong-Hui Lein MD, Ching-Shui Huong (2002) Male gender. Risk factor for severe symptomatic cholelithiasis. World j Surg 26: 598-601.
Lee KW, Poon CM, Leung KF et al (2005) Two-port needlescopic cholecystectomy: prospective study of 100 cases. Hong Kong Med J. Feb; 11 (1): 30-35.
Borutan AG, Klein D, Kilian M et al (2020) Long-term follow-up after single incision laparoscopic surgery. Surg Endos, Jan; 34 (1): 126-132.
Bulian DR, Knuth J, Lehmamm KS et al (2015). Systematic analysis of the safety and benefits of transvaginal hybrid NOTES cholecystectomy. World J Gastroenterol, Oct 14; 21 (38): 10915-23.
Fried GM, Borkun JS, Sigman HH et al (1994) Factors determining conversion to laparotomy in patients undergoing Laparoscopic Cholecystectomy. Am J Surg 167: 35-41.
Rosen M, Brody F, Ponsky J (2002) Predictive factors for conversion of Laparoscopic Cholecystectomy. Am J Surg 184: 254-258.
Lal P, Agarwal NP, Malik VK, Chakarvati AL (2002) A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS Jan-Mar 6 (1): 59-63.
Nakeeb A EI, Mahdy Y, Salem A et al (2017) Open Cholecystectomy has a place in the Laparoscopic Era: a retrospective cohort study. Inj J Surg 79 (5): 437-443.
Browse journals by subject