Factors affecting the conversion to open surgery during laparoscopic cholecystectomy in patients with cholelithiasis undergoing ERCP due to choledocholithiasis.

BACKGROUND: The rate of conversion to open surgery is high in laparoscopic cholecystectomy (LC) after Endoscopic Retrograde Cholangiopancreotocography (ERCP). The present study aimed to evaluate the risk factors associated with the conversion to open cholecystectomy and minimize the rate of conversion to open surgery. METHODS: A total of 157 patients admitted to the Ondokuz Mayis University Medical Faculty Hospital due to cholelithiasis and choledocholithiasis between January 2002 and December 2012, and they receiving laparoscopic cholecystectomy were included in the study. The patients were analyzed retrospectively. The predictive factors for conversion to open cholecystectomy were evaluated. Patients were compared to each other in terms of time passing from ERCP to operation, number of ERCPs, stent usage, stone extraction and complications that occurred while waiting for the operation. Patients were separated into three groups according to the time passing from ERCP to laparoscopic cholecystectomy, as follows; group I (short time intervals: 7 days or less): 53 patients, group II (intermediate time intervals: 8-42 days): 70 patients and group III (long time intervals: 43 days and more): 34 patients. RESULTS: Of the 157 patients, 57 were male and 100 were female. The mean age was 54.5 (range: 19-87) years. Of these 157 patients who received laparoscopic cholecystectomy following ERCP, 22 (14%) underwent open surgery. The conversion to open cholecystectomy was distributed in groups, as follows: seven (13.2%) patients in group I, eight (11.4%) patients in group II and seven (20.6%) patients in group III. When the rate of conversion to open surgery was compared between groups, there was no statistically significant difference (p=0.406). The laparoscopic operations were converted to open surgery in 15 (11.3%) of the 133 patients who underwent single ERCP, and in seven (29.2%) of the 24 patients who underwent two or more ERCPs before surgery (p=0.048). The number of ERCPs was determined to be the most important factor that affects the conversion to open surgery in laparoscopic cholecystectomies following ERCP. The removal of stones from the common bile duct, stent placement in the common bile duct, and existence of biliary complications during waiting time from ERCP to LC had no effect on the conversion to open surgery (p=0.454, p=0.058, and p=0.465, respectively). CONCLUSIONS: The results of this study reveal that the timing of LC following ERCP, removal of stones from the common bile duct, stent placement in the common bile duct and the existence of biliary complications during the waiting period have no effect on the rate of conversion to open surgery. The number of ERCPs is the only factor that affects the conversion to open surgery in LC following ERCP. KEY WORDS: Choledocholitiasis, Conversion, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy.

Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer.

PURPOSE: Studies demonstrate an increasing rate of contralateral prophylactic mastectomy (CPM). The purpose of this study is to evaluate decision making and factors influencing women's long-term satisfaction with CPM. Descriptive analysis is used to analyze the results of our designed questionnaire approved by our Institutional Review Board. METHODS: We searched our institutional cancer registry for patients diagnosed with breast cancer between 2000 and 2010. The studied time frame is of significance as this study is the first to measure response rate in questions examining patient satisfaction for >1 year after undergoing CPM. The questionnaire was mailed to all consented participants to examine factors contributing to the choice of CPM and postoperative satisfaction. RESULTS: Of the 206 women included in the study, 147 were aged up to 50 years. Majority of women who underwent CPM in this cohort was with a bachelor's degree or higher, married or partnered women, and women earning >$60,000/y. Almost all women were "happy with overall surgery" and would recommend CPM to other patients. Psychological factors, such as fear of recurrence, were more commonly associated with the decision for CPM in patients with invasive carcinoma. Opinions of partners, relatives, friends, and physicians further contributed to the decision to undergo surgery. The availability of reconstruction was also an influential factor in the overall decision. CONCLUSIONS: The majority of our study participants experienced long-term satisfaction with the surgical procedure of CPM. From our analysis, we can confidently say that fear of cancer recurrence and the opinions of others, among other factors, were influencing contributors toward the decision of undergoing CPM.