Our Summary

This research paper is about a study that aimed to identify factors that could predict if a laparoscopic cholecystectomy (a minimally invasive surgery to remove the gallbladder) would need to be converted into an open surgery. The study analyzed data from 1323 patients who underwent this procedure at two university hospitals in Italy.

The study found that patients with a higher American Society of Anesthesiologists (ASA) score, which is a system for assessing the fitness of patients before surgery, and those with certain health conditions (like cardiovascular disease, diabetes, and chronic kidney disease) were more likely to need their surgery converted to an open procedure.

Older patients also had a higher risk of needing a conversion. However, having had previous abdominal surgery or episodes of gallbladder inflammation or pancreatitis didn’t significantly affect the likelihood of needing a conversion.

The study also found that the risk of complications after surgery was higher in the group of patients whose surgery was converted to an open procedure, but the risk of death after surgery and the likelihood of being discharged home were not significantly affected by whether a conversion was needed or not.

In conclusion, the study found that many of the factors that increase the risk of needing a conversion to open surgery can’t be changed by delaying the surgery.

FAQs

  1. What factors were found to increase the likelihood of a laparoscopic cholecystectomy being converted into an open surgery?
  2. Does a previous history of abdominal surgery or gallbladder inflammation increase the risk of needing a conversion to open surgery?
  3. Does conversion from laparoscopic cholecystectomy to open surgery affect the risk of complications, death, or the patient’s ability to be discharged home?

Doctor’s Tip

Therefore, it is important for patients to discuss their medical history and any underlying health conditions with their doctor before undergoing a laparoscopic cholecystectomy. Additionally, following any pre-operative instructions given by the doctor, such as fasting before surgery and stopping certain medications, can help reduce the risk of needing a conversion to open surgery. It’s also important for patients to follow their doctor’s post-operative instructions closely to minimize the risk of complications and ensure a smooth recovery.

Suitable For

Patients with higher ASA scores, certain health conditions, and older age are typically recommended for laparoscopic cholecystectomy. However, it is important for healthcare providers to carefully assess each patient’s individual risk factors and make personalized recommendations based on their specific circumstances.

Timeline

Before laparoscopic cholecystectomy:

  1. Patients may experience symptoms of gallbladder issues such as abdominal pain, nausea, and vomiting.
  2. Patients undergo diagnostic tests such as ultrasound or MRI to confirm gallbladder disease.
  3. Patients may be advised to follow a specific diet or medication regimen to manage symptoms before surgery.

After laparoscopic cholecystectomy:

  1. Patients typically experience less pain and a quicker recovery compared to open surgery.
  2. Patients may have some discomfort or bloating in the abdomen post-surgery.
  3. Patients are usually discharged from the hospital within a day or two after surgery.
  4. Patients are advised to follow a specific diet and activity restrictions for a few weeks post-surgery.
  5. Patients may have follow-up appointments with their surgeon to monitor their recovery and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic cholecystectomy include:

  1. What is the likelihood of my laparoscopic cholecystectomy needing to be converted to an open surgery?
  2. How does my American Society of Anesthesiologists (ASA) score affect the risk of conversion?
  3. What specific health conditions increase the risk of needing a conversion?
  4. Does my age impact the likelihood of needing a conversion?
  5. How do previous abdominal surgeries or episodes of gallbladder inflammation or pancreatitis affect the need for conversion?
  6. What are the potential complications associated with a conversion to open surgery?
  7. How does the need for conversion to open surgery impact my recovery and discharge process?
  8. Are there any steps I can take to reduce the risk of needing a conversion to open surgery?
  9. What is the overall success rate of laparoscopic cholecystectomy at your facility?
  10. What post-operative care and follow-up will be necessary after the surgery?

Reference

Authors: Vaccari S, Cervellera M, Lauro A, Palazzini G, Cirocchi R, Gjata A, Dibra A, Ussia A, Brighi M, Isaj E, Agastra E, Casella G, Di Matteo FM, Santoro A, Falvo L, Tarroni D, D’andrea V, Tonini V. Journal: Minerva Chir. 2020 Jun;75(3):141-152. doi: 10.23736/S0026-4733.20.08228-0. Epub 2020 Mar 4. PMID: 32138473