Reasons for conversion of laparoscopic cholecystectomy to conventional cholecystectomy, in a tertiary care hospital

Objective: To determine and assess the common causes of conversion of laparoscopic cholecystectomy to conventional cholecystectomy

Methods: A cross sectional hospital based study was conducted in Surgical Unit-III, Abbasi Shaheed Hospital and Karachi Medical and Dental College. Overall 197 patients were selected through consecutive non probability sampling. Patients included were those with symptomatic cholelithiasis including acute cholecystitis, chronic cholecystitis and asymptomatic gall stones in which ultrasound abdomen demonstrated cholelithiasis with normal common bile duct. Written consent was taken from each admitted patients and assessed clinically androutine investigations [CBC, ESR, RBS, Urea, Creatinine, Liver Function test, Hepatitis Profile, X-ray chest, ECG and ultrasonography of abdomen] were done. Laparoscopic cholecystectomy was done under general anesthesia

Results: Laparoscopic cholecystectomy was successful in 188 patients [95.43%] while in 9 patients [4.59%] laparoscopic cholecystectomy was converted to open cholecystectomy

Conversion was because of haemorrhage in one patient [0.51%], Common bile duct injury inone patient [0.51%], non-visualization of gall bladder in one patient [0.51%], shortage of time for laparoscopic cholectectomy in two patients [.02%], cholecystoduodenalfistula in two patients [1.02%] while two patients [1.02%] were converted to open procedure due to carcinoma gall bladder

Conclusion: The conversion rate was five percent from laparoscopic cholecystectomy to open cholecystectomy hence laparoscopic cholecystectomy is a safe procedure

The knowledge of common reasons of conversion in our tertiary hospital will help to overcome these factors in future, which benefit in reducing cost and improve patients wellbeing

Desmoid tumour of lower abdomen

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report a case of a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour

Bilobed gallbaldder

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration