LAPAROSCOPY TO OPEN CHOLECYSTECTOMY

The standard treatment for gall bladder removal is laparoscopic cholecystectomy. The factors which influence the successful laparoscopic cholecystectomy are:

1). Severity of disease (Less severe disease has better outcome).

       Severe acute cholecystitis, empyema of gall bladder, gall bladder perforation, gangrenous cholecystitis and acute on chronic cholecystitis patient will have technical difficulty in identifying the structures in the Calot’s triangle. Also, the presence of chronic liver disease patient will also have technical difficulty in proceeding with laparoscopic cholecystectomy, because of presence of extensive venous collaterals may increase the bleeding tendency.

2). Anatomical anomalies

      Presence anatomical anomalies in the area of operation will be technically difficult than without anatomical anomalies. If MRCP is done before surgery, these anomalies will be identified before surgery. But if MRCP is not done before surgery and if any anatomical anomalies are suspected during laparoscopic cholecystectomy and if the surgeon feels open surgery is the better option, then it is better to proceed with open cholecystectomy (Laparoscopy converted to open cholecystectomy)

3). In case of co-existing jaundice or biliary pancreatitis

      The presence of jaundice due to bile duct stones or biliary pancreatitis can have technical difficulty in proceeding with laparoscopic cholecystectomy because of extensive adhesions over the Calot’s triangle area. In this situation if there is any difficulty in identifying the vital structures then open cholecystectomy will be an ideal option.

4). Inadequate technical facility.

      Availability of all required equipment including ICG facility is very important to complete the surgery through laparoscopic technique. In case of any technical problem like problem with camera system, light source and insufflator then conversion to open cholecystectomy will be an ideal option.

 5). Experience of the surgical team

      Experience of the surgeon and the team is also an important factor for successful laparoscopic cholecystectomy.

      Laparoscopy is a technique used to treat the gall stone disease without opening abdomen. But safety of the procedure is more important than the actual technique. So, during laparoscopic cholecystectomy, in case of any technical difficulty the laparoscopic procedure will be converted to open surgical procedure. This decision will be made during the same surgery itself. So, conversion of laparoscopy surgical procedure to open surgical procedure is an accepted one. The decision of laparoscopic cholecystectomy to open cholecystectomy is very important and has to be taken in right time. The decision to make conversion should not be takes as failure. Also consent for conversion of laparoscopic cholecystectomy to open cholecystectomy will be obtained before surgery from all the patients and patient’s attender, so the procedure can be completed during the same sitting.