|
Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0972-2823
Vol. 51, Num. 2, 2005, pp. 153-153
|
Journal of Postgraduate Medicine, Vol. 51, No. 2, April-June, 2005, pp. 153
Letters
Conversion from laparoscopic to open cholecystectomy
Bhattacharya Kaushik
Department of Surgery, Subham Hospital and Diagnostic Centre, Cooch Behar - 736101, West Bengal
Correspondence Address: Department of Surgery, Subham Hospital and
Diagnostic Centre, Cooch Behar - 736101, West Bengal, kaushik_srmc@rediffmail.com
Code Number: jp05060
Sir,
I read the article by Tayeb et al[1] with interest. Even though the authors have identified the majority of risk factors for conversion to open cholecystectomy, I don′t know why the sex of the patient was not considered. Male gender has been a significant risk factor for a high conversion rate in majority of the studies.[2],[3] Another factor is the time of surgery from the onset of symptoms. Patients undergoing intervention within 48 hours of the onset of symptoms experience a lower conversion rate to an open procedure.[4] A study from Belgium highlighted that preoperative C reactive protein seric level less than 10 mg% represent the best candidates for laparoscopic surgery.[5] In another study, the American Society of Anaesthesiologist (ASA) class of more than 2 also predicted conversions in patients undergoing non-elective cholecystectomies.[6] Finally, no matter how much preoperative risk grading or a diagnostic score is done to predict difficult laparoscopic cholecystectomy, the experience of the surgeon is the foremost factor. There should always be a low threshold of conversion whenever he faces any difficulty irrespective of the preoperative predictability.
REFERENCES
| 1. | Tayeb M, Ahsan RS, Khan MR, Azami R. Conversion from laparoscopic to open cholecystectomy : Multivariate analysis of preoperative risk factors. J Postgrad Med 2005;51:17-20. Back to cited text no. 1 |
| 2. | Nachnani J, Supe A. Pre -operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol 2005;24:16-8. Back to cited text no. 2 |
| 3. | Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic cholecystectomy . Am J Surg 2004;188:205-11. Back to cited text no. 3 [PUBMED] [FULLTEXT] |
| 4. | Madan AK, Aliabadi- Wahle S, Tesi D, Flint LM, Steinberg SM. How early is early laparoscopic treatment for acute cholecystitis ?. Am J Surg 2002;183:232-6. Back to cited text no. 4 |
| 5. | Lunbosch JM, Druart ML, Puttemans T, Melot C. Guidelines to laparoscopic management of acute cholecystitis. Acta Chir Belg 2000;100:198-204. Back to cited text no. 5 |
| 6. | Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184:254-8. Back to cited text no. 6 [PUBMED] [FULLTEXT] |
Copyright 2005 - Journal of Postgraduate Medicine
|
