Abstract:
Aim: We aimed to investigate the role of histopathologic alterations of gallbladder wall in conversion cholecystectomy.
Material and Methods: 3338 laparoscopic cholecystectomies and 121 conversion cholecystectomies that were performed between
January 2008 and June 2017 in our hospital were evaluated. Patients were divided into 2 groups as laparoscopic and conversion
cholecystectomy groups. Both groups were compared retrospectively by examining the histopathologic data of 140 patients were
randomly analyzed.
Results: There was a statistically significant difference between the types of surgery according to necrosis, polymorfonuclear
leucocystes, mononuclear cells, edema levels (p <0.01). The incidence of polymorfonuclear leucocystes and mononuclear cells was
at the marked and massive levels in cases with conversion cholecystectomy which were higher than in those with laparoscopic
cholecystectomy. The rate of severe edema seen in conversion cholecystectomy was higher than in laparoscopic cholecystectomy (p
<0.01). There was a statistically significant difference between the types of surgery according to granulation tissue, neoangiogenesis
and fibroblast levels (p <0.01). There was a statistically significant difference between the necrosis-edema duple levels and
Verhofstadt scores of the cases according to the operation type (p <0.01).
Conclusion: Cholelithiasis histopathology that evaluates intra-mural factors has significant effects on conversion cholecystectomy
with extra-mural factors. The increase in Verhofstadt score and Necrosis-Edema duple has been shown to increase the risk of
conversion cholecystectomy surgery with great sensitivity. Preoperative superb microvascular imaging and contrast-enhanced
ultrasound may helpful in detecting the necrosis and edema in the gallbladder wall which has also the potential to predict the risk of
conversion cholecystectomy
