Conversion of laparoscopic to open cholecystectomy: identification of preoperative risk factors

Introduction: Laparoscopic cholecystectomy has become the standard operative prodedure for cholelithiasis; however, approximately 5% to 15% of patients require conversation to open surgery for various reasons. The issue of this conversion remains unsettled. Conversion exerts adverse effects on operating time, postoperative morbidity, and hospital costs. We aimed in this current study to identify the risk factors that may predict conversion of laparoscopic cholecystectomy to open surgery

Patients and methods: A retrospective analysis of medical records of 143 patients who underwent laparoscopic cholecytectomy, including demographic, ultrasonographic, and operative and postoperative data. Preoperative risk factors affecting conversion to open surgery were identified with statistical analysis

Results: Increased risk of conversion with statistical significance was found in advanced age[OR=12.16], male gender [OR=6.86], obesity [OR=5.22], diabetes [OR=31.5], previous abdominal surgery [OR=8.20], emergency laparoscopic cholecystectomy for acute cholecystitis [OR=9.75] and thickened gallbladder wall on ultrasonographic scanning [OR=7.27]. No significant relation was found between the likelihood of conversion and any of the following: concomitant diseases [cardiovascular diseases or cirrhosis], preoperative ERCP, and preoperative abnormal liver function test results

Conclusion: knowledge of these factors will help the surgeon to counsel and select the patient, arrange the operating schedule, and plane of the duration of convalescence but they were not contraindication for the operating schedule, and plane of the duration of convalescence but they were not contraindication for laparoscopic cholecystectomy

Curative effect of bone marrow transplantation on irradiated liver and plasma proteins

The histopathological examination of mice liver exposed to whole body gamma irradiation [6 Gy] followed by bone marrow transplantation [BMT], showed a moderate degree of recovery after 20 days. Parallel electrophoretic analysis of plasma proteins revealed significant increase only in alpha and gamma-globulins. Accordingly, it could be assumed that BMT ameliorated partially the liver histopathology and the level of certain plasma proteins after 20 days, so it could be considered as a convenient therapy following whole body gamma- irradiation