2020 Volume 17 Issue 3 Pages 142-147
Purpose: The Tokyo Guidelines 2018 (TG18) recommends conversion of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) as a bailout procedure (BOP) for patients in whom LC cannot be performed safely. However, the treatment results of OC are reported to be poorer than those of LC. Herein, we investigated the treatment results in patients with acute cholecystitis who required conversion to OC from LC and the factors involved in the conversion to OC. In addition, we also evaluated the outcomes of laparoscopic subtotal cholecystectomy (LSC), which is another BOP for LC. Methods: We investigated the following items in 418 patients with acute cholecystitis who underwent LC at our institution between January 2001 and September 2019: age, sex, severity of acute cholecystitis, presence/absence of gallstones, white blood cell(WBC) count and serum C–reactive protein(CRP) immediately before the surgery, use of preoperative drainage and the type of drainage, operation time, blood loss, total length of hospital stay, length of postoperative hospital stay, complication rate, and results of histopathology. Results: All of the items investigated were significantly worse in the patients who required conversion of LC to OC as compared to those in the patients treated by LC: operation time(151 min. vs. 254 min., P＜0.001), intraoperative blood loss(26.2 mL vs. 348.8 mL, P＜0.001), complication rate (3.8％ vs. 19.0％, P＜0.001), total length of hospital stay(21 days vs. 38 days, P＜0.001) and length of postoperative hospital stay(9 days vs. 22 days, P＜0.001). In addition, the operation time and total length of hospital stay were also worse in the patients who required conversion to OC from LC as compared to those who were treated by LSC. Factors involved in the conversion to OC included intraperitoneal factors, gallbladder bed fibrosis, and fibrosis in Calot’s triangle. The latter two factors were the causes for the prolongation of the operation time and increase of the blood loss. In consideration of the patients’ safety, it seems desirable to complete cholecystectomy using a laparoscopic technique, including LSC, as needed.
