Reasons for conversion to open surgery reported in literature include injury to bowel and major blood vessels, bleeding, avulsion of cystic duct, duodenal injury, cholecystoduodenal fistula, respiratory acidosis, dense adhesions at Calot's triangle, difficult and obscure anatomy, severe inflammation, injury to bile ducts, abnormal intraoperative cholangiogram, unsuspected pathology and equipment failure10.
One patient had diagnosis of gallstone pancreatitis and another patient was of empyema gallbladder that turned out to have cholecystoduodenal fistula.
Reasons for conversion to open surgery included bleeding from avulsion of cystic artery (n=2), difficulty in controlling oozing of blood from liver bed (n=1), cholecystoduodenal fistula (n=1), adhesions/difficult anatomy at Calot's triangle (n=1), cystic duct avulsion (n=1) and common hepatic duct injury (n=1).
A cholecystoduodenal fistula
was left intact because the chances of recurrence are very low and the patient did not have residual gallstones.
In about 50% there is a history of jaundice, either in the past or at presentation, and loose bowel motions may be associated with a cholecystocolonic fistula (7) Severe haemorrhage complicating cholecystoduodenal fistula
has also been reported (7).
Upon relieving the obstruction, a cholecystoduodenal fistula was palpated and also visualized via the endoscope.
The most common findings include a filling defect or mass in the duodenum, a gallstone in the duodenum, duodenal or pyloric obstruction, cholecystoduodenal fistula, and pneumobilia.
Neither closure of the cholecystoduodenal fistula nor cholecystectomy was performed.
5%) the procedure was converted to open cholecystectomy (OC) due to finding of cholecystoduodenal fistula on laparoscopy.
5%) patient the procedure was converted to OC due to findi ng of cholecystoduodenal fistula on laparoscopy.
During the operation, the presence of a cholecystoduodenal fistula
was confirmed, and signs of bile duct ischemia were found.
5% to 14% of cases conversion of LC to OC is needed8-10due to massive bleeding bile duct injuries obscure anatomy bowel injuries and cholecystoduodenal fistula
although surgeons do not consider it a complication.