Abstract

Introduction: Laparoscopic cholecystectomy offers less cardiopulmonary complication and wound infection than open surgery and became the treatment of choice for symptomatic gallstones, acute and chronic cholecystitis but it has twice the rate of the catastrophic bile duct injuries than open surgery. The health care providers should have clear understanding of the factors associated with bile duct injury (BDI) & conversion to predict those undesirable events prior to surgery and prepare appropriate measures. The objective of this study was to determine factors associated with BDI and conversion in laparoscopic cholecystectomy.

Methods: This is a prospective, descriptive study included patients above 13 years old who underwent laparoscopic cholecystectomy from different hospitals in Aden, Yemen during the period 1^st Jan. 2022 to 31^th Dec. 2022. Analysis was performed using the Statistical Package for Social Sciences (SPSS V.22). Variables were analyzed for association with BDI & conversion. Significance level was taken at p < 0.05 level.

Results: The study enrolled 336 patients, 283 females (84.2%) and 53 males (15.8%). The conversion to open cholecystectomy was performed in 15 patients with conversion rate 4.5%. Complications were observed in 32 patients with overall morbidity of 9.5% and without mortalities. BDI was observed in eleven patients (3.3%), two patients had major BDI and underwent subsequent Roux-en-Y hepatico-jejunostomy. There was statistically significant association in conversion with male gender (p=0.001), acute calcular cholecystitis (p=0.003), ultrasonography findings of contracted gallbladder (p=0.025), impacted gallbladder stone (p=0.024) and preoperative retrograde cholaniopancreatography (ERCP) (p=0.012) while acute calcular cholecystitis (p=0.006) and ultrasonographic findings of contracted gallbladder (p=0.014) or thickened gallbladder wall ≥ 4 mm (p<0.001) were significantly associated with duct injuries.

Conclusion: Male gender, acute calcular cholecystitis, preoperative ERCP and preoperative ultrasonography findings of contracted gallbladder or impacted gallbladder stone were factors associated with conversion from laparoscopic to open surgery while acute calcular cholecystitis and ultrasonographic findings of contracted gallbladder or thickened gallbladder wall ≥ 4 mm were significantly associated with bile duct injuries.

Keywords: Laparoscopic Cholecystectomy, Bile duct injury, Conversion, Risk.

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