Abstract
A RESEARCH STUDY OF CHOLECYSTECTOMIES AND REASONS OF CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMIES IN A TERTIARY CARE HOSPITAL

Dr. P. Vinay*, Dr. K. Gowtham Reddy, Dr. T. Mahendra, Dr. P. Gowtham Reddy and M. Venkata Subbaiah

ABSTRACT

Cholelithiasis involves the presence of gallstones which are concretions that form in the biliary tract, usually in the gallbladder. Treatment of gallstones depends on the stage of disease. By using the following diagnostic methods, the condition can be identified. Laparoscopic Cholecystectomy (LC) - The surgery to remove the gallbladder is called a cholecystectomy. Open Cholecystectomy (OC) - The gallbladder is removed through an incision on the right side under the ribcage. The reasons include difficult dissection, operative findings and surgery. Our study conducted in subjects admitted with diagnosis of cholelithiasis, who subsequently underwent cholecystectomy at Department of General Surgery Rajiv Gandhi Institute of Medical Sciences in study period between Jan 2011 and Dec 2015. This is a prospective descriptive analytical single centre research study and in this all the cases of gall bladder diseases admitted in surgery department undergoing cholecystectomy were studied, diagnosed and treated with surgical management (Laparoscopic or Open) during the period of 5 years and 196 cases were studied. The results shown that the high incidence in the age group of 40-50 years have undergone the surgery and predominantly females compared to males due to a large extent owing to ovarian hormones. The type of cholecystectomy performed more is laparoscopic (66.32%) due to few benefits over open-type surgery (21.93%) and with the conversion rate (11.73%). The conversion of LC to OC is due to the reasons like complications, difficult dissection and the operative finding associated with pathology. The main reasons for conversions are disturbed anatomy at Calot’s triangle (34.78%) and bleeding from GB bed (21.73%). Finally concluding the study LC has emerged as the gold standard in the treatment of gall stones. LC has less pain after surgery, and has a shorter hospital stay and a shorter recovery time so it is preferred over OC. The overall frequency of conversion of LC to OC was 11.79%; the risk of conversion is more during the learning curve and in male patients, but increasing age is not associated with increased risk of conversion. Although unclear anatomy at Calot's triangle and bleeding from GB bed remain the most common reasons for conversion, the use of refurbished equipments was also a cause of concern.

Keywords: Laparoscopic Cholecystectomy (LC) and Open Cholecystectomy (OC).


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