Effect of Difficult Common Bile Duct Stone on Conversion Rate from Laparoscopic to Open Cholecystectomy

Abstract

Objective: This study aimed to evaluate the effect of difficult common bile duct (CBD) stone on conversion rate of Laparoscopic cholecystectomy (LC). In addition, this study evaluated the effect of difficult CBD stone on operative time and complications in LC procedures. Material and Methods: The medical records at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University; from January 2017 to December 2021, were retrospectively reviewed. We enrolled patients with CBD stone having undergone endoscopic retrograde cholangiopancreatography (ERCP), followed by LC. Difficult CBD stones was defined as: a stone diameter >1.5 cm, biliary stricture, Mirizzi’s syndrome, cystic duct stone or stone that could not be extracted in the first ERCP. Results: Of the 140 patients, a total of 40.7% were male. The mean age was 60.8 years. From this 30% of patients had difficult CBD stones. The conversion rate was 10%. By univariate analysis, the difficult CBD stone was statistically significantly associated with a predictor of conversion rate (r=0.30, p-value<0.001). The odds ratio was 7.34 (95% confidence interval (CI) 2.15-25.05, p-value=0.001). From the result of LC, operation time (p-value=0.002), overall complications (p-value=0.003) and length of hospital stay (p-value=0.002) were significantly higher in difficult than non-difficult CBD stones. Conclusion: Difficult CBD stones could increase the conversion rate from laparoscopic to open cholecystectomy, which requires more operation time, has complications and longer length of hospital stay than non-difficult CBD stones in LC procedures. LC after ERCP in this group should be carefully performed by an experienced surgeon.