Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. Conversion to an open procedure is necessary in 5–10% of patients. The aim of work: The present study was to illustrate the
incidence of conversion of laparoscopic cholecystectomy to open cholecystectomy & to validate the efficacy of “CLOC" (Conversion from Laparoscopic to open cholecystectomy) risk scoring system on the patients included in the study.
Patients and methods: The present observational prospective study was conducted in EL-Demerdash Teaching Hospital (January 2019- January 2020). The study included (100) symptomatic cholelithiasis patients. Patients were divided into two groups, firstly those who completed laparoscopic cholecystectomy and secondly those who were converted into open cholecystectomy. Preoperative variables included patient demographics, indications for surgery, ASA grade, admission type, ultrasound findings and preoperative endoscopic retrograde cholangiopancreatography (ERCP). Validation of the “CLOC" scoring system was applied to all patients. Operative data were gathered prospectively, and the difficulty of the
procedure was graded using the Nassar scale (grades 1–4). Results: (24%) of patients recorded difficult total score; open
surgery was conducted in (5%). There was statistically significant relation between CLOC risk scoring level and age (p < 0.001); indication (p=0.002); ASA (p=0.002); gallbladder wall thickness. (p < 0.001) and preoperative ERCP patients (p=0.003). There was statistically significant increase in difficulty in male compared to female. (p=0.019). There was actual conversion according to groups with ‘high risk scoring >7 and conversions in the' low risk >6 easy' group below. (p=0.042); highly statistically significant increase of mean in difficult group compared to essay group (p < 0.001). The
difficult group complications rate was higher than the easy group (75% versus 10.5%); gallbladder rupture was mostly reported in (37.5% and 2.6%) of difficult group and easy group cases, respectively. Receiver operating characteristics (ROC) curve sensitivity was 92%; specificity was 98.7%. Age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty. Conclusion: The present study could conclude that parameters
as older age, male gender, cholecystitis, ASA, thick wall GB, preoperative ERCP are predictors for difficult LC. Meanwhile these factors are predictors for conversion to open cholecystectomy. CLOC" risk score may be the most helpful tool in stratifying risks.