CONVERSION RATE OF LAPAROSCOPIC CHOLECYSTECTOMY AT SEBOKENG HOSPITAL

Introduction. Laparoscopic cholecystectomy (LC) is the most common laparoscopic procedure performed electively by general Surgeons worldwide. Some series report success in almost 100% of cases with conversion to an open procedure approaching 0%. But if poorly performed, LC can result in serious complications and death. Therefore it is very important that trainee Surgeons acquire the skill to perform LC safely. Aim. To evaluate LC at a level II registrar training centre with attention to complications, the rate of conversions and final outcomes Methods. Retrospective review of patients' record collected from November 2011 to October 2012 at Sebokeng Hospital. Data analysed included patient demographics, level of surgeon's expertise, rate and reason for conversion, post-operative complications, the indications for ERCP (endoscopic retrograde cholangiopancreatography), histopathology and final outcome. Results. A total of 64 LC were performed. There were 56 females and 8 males with a mean age of 45 years (range, 21-75). The histopathological examination revealed 3 cases of acute severe cholecystitis, 6 cases of active chronic and 38 cases of chronic cholecystitis. In three patients the gallbladder was described as normal and no results were available for 9 patients while three cases were rejected (unsuitable for examination). 8 patients had ERCP (7 pre-operative and one post-operative). Three level of expertise were involved. The trainers (specialist surgeons, principal medical officers) and the trainees (registrars). The trainees performed 56.2% (36/64) of LC, 8 of them unsupervised (trainers not scrubbed but present in theatre on and off). The laparoscopy success rate was 95.3% and overall survival 98.4%. There was one bile leak and three conversion (4.6%) with one associated mortality (1.5%). Conclusion. With 50% of the procedure performed by the trainees at a level II hospital, the conversion rate of 4.6% and 1.5% of complications with overall survival of 98.4% are commendable.