Reasons for conversion of laparoscopic surgery into open surgery in patients of acute abdomen

Objectives: To determine frequency and the reasons of conversion laparoscopic procedure into open surgery. Methodology: This prospective cross sectional study was conducted in department of surgery, Khyber Teaching Hospital, Peshawar, Pakistan from January 2015 to July 2016. A sample of 200 patients was selected by using non probability convenient sampling technique. Complicated cases, which were difficult to handle by laparoscope, were converted to open surgery after diagnoses were made while rests of cases were managed by laparoscopy at same time. Data were analyzed by SPSS version 16. Results: Out of 200 patients, 135(67.5%) were males, 65(32.5%) females, 76(38%) from urban while 124(62%) from rural area. Mean age was 35 +/- 11 years (range 15-85). 41(20.5%) were diabetics, 36(18%) were hypertensive while 26(13%) were smokers. Diagnosis was made successfully in all patients in whom acute appendicitis was most frequent (74.5%) followed by perforated duodenum in 6.5% of cases. In 22(11%) of cases the laparoscopy was converted into open procedure. The reasons of conversion in case of acute appendicitis were advance adhesions (25.75%), severe inflammation (35.25%) and bleeding in 34% of patients. Conclusion: About one tenth of laparoscopic procedures were converted into open procedures. Reasons of conversion of laparoscopic procedures into open surgery in case of acute abdomen were adhesions, previous abdominal surgeries, severity and time of presentation of perforations, severe inflammation, severe bleeding and difficulties in visualization of anatomy.