Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Surg Endosc. 2023 Oct;37(10):8072-8079. doi: 10.1007/s00464-023-10373-7. Epub 2023 Aug 28.
Laparoscopy has a clear patient benefit related to postoperative morbidity but may not be as commonly performed in low-and middle-income countries. The decision to convert to laparotomy can be complex and involve factors related to the surgeon, patient, and procedure. The objective of this work is to analyze the factors associated with conversion in laparoscopic surgery in a low-resource setting.
This is a single-center prospective study of patients who underwent laparoscopic surgery between May 1, 2018 and October 31, 2021. The parameters studied were age, sex, body mass index (BMI), intraoperative complication (e.g., accidental enterotomy, hemorrhage), equipment malfunction (e.g., technical failure of the equipment, break in CO supply line), operating time, and conversion rate.
A total of 123 laparoscopic surgeries were performed. The average age of patients was 31.2 years (range 11-75). The procedures performed included appendix procedures (48%), followed by gynecological (18.7%), gallbladder (14.6%), digestive (10.56%), and abdominal procedures (4%). The average length of hospitalization was 3 days (range 1-16). Conversion to laparotomy was reported in 8.9% (n = 11) cases. Equipment malfunction was encountered in 9.8% (n = 12) cases. Surgical complications were noted in 11 cases (8.9%). Risk factors for conversion were shown to be BMI > 25 kg/m (OR 4.6; p = 0.034), intraoperative complications (OR 12.6; p = 0.028), and equipment malfunction (OR 9.4; p = 0.002).
A better understanding of the underlying factors associated with high conversion rates, such as overweight/obesity, intraoperative complications, and equipment failure, is the first step toward surgical planning to reduce postoperative morbidity in low-resource settings.
腹腔镜手术具有明显的术后发病率降低的患者获益，但在中低收入国家可能并不常见。转为开腹手术的决定可能很复杂，涉及与外科医生、患者和手术相关的因素。这项工作的目的是分析在资源匮乏环境下腹腔镜手术中转开腹的相关因素。
这是一项单中心前瞻性研究，纳入了 2018 年 5 月 1 日至 2021 年 10 月 31 日期间接受腹腔镜手术的患者。研究的参数包括年龄、性别、体重指数（BMI）、术中并发症（例如，意外肠切开术、出血）、设备故障（例如，设备技术故障、CO 供应线中断）、手术时间和中转率。
共进行了 123 例腹腔镜手术。患者的平均年龄为 31.2 岁（范围 11-75 岁）。手术类型包括阑尾切除术（48%），其次是妇科手术（18.7%）、胆囊切除术（14.6%）、消化系统手术（10.56%）和腹部手术（4%）。平均住院时间为 3 天（范围 1-16 天）。报告有 8.9%（n=11）例中转开腹。有 9.8%（n=12）例发生设备故障。有 11 例（8.9%）出现手术并发症。中转的风险因素包括 BMI>25kg/m2（OR 4.6；p=0.034）、术中并发症（OR 12.6；p=0.028）和设备故障（OR 9.4；p=0.002）。
更好地了解与高中转率相关的潜在因素，如超重/肥胖、术中并发症和设备故障，是制定手术计划以降低资源匮乏环境下术后发病率的第一步。
