Analysis Of Risk Factors And Timing Of Conversion To Laparotomy In Laparoscopic Pancreaticoduodenectomy

Objective: Conversion to laparotomy that derived from laparoscopic pancreaticoduodenectomy(LPD)should not be overlooked.There are few reports on whether conversion to laparotomy is beneficial for high-risk LPD.The study aim to analyze the risk factors of conversion to laparotomy in LPD and to explore the timing of conversion to laparotomy in high-risk LPD.Methods:From May 2014 to September 2019,437 patients underwent LPD were selected in the hepatobiliary surgery of the second hospital of Hebei Medical University.421 patients successfully completed LPD,16 patients were converted to laparotomy,the conversion rate was 3.66%.Pre-,peri-and postoperative data of all patients were collected to analyze the risk factors that lead to conversion of LPD to open surgery,and to explore the timing of conversion to open surgery for high-risk LPD in terms of operation length and estimated bleeding loss(EBL).Results: In the risk factor analysis,there were significant difference between the LPD group and the conversion group in chronic pancreatitis,abdominal operation history,tumor sites,vascular resection and reconstruction(P<0.05).There was no significant difference between two groups in gender,age,BMI and diabetes(P>0.05).When the operation length ?450min or EBL ?2000ml,total postoperative morbidity were all significantly increased(45.16%,61.54%).Further research found that total postoperative morbidity in the conversion group was lower than that in the LPD subgroup(operation length ? 450 min,n=180),12.50% and 37.22%,respectively,with significantly difference(P<0.05),and that in the LPD subgroup(EBL ? 2000 ml,n=24),12.50% and 50.00%,respectively,with significantly difference(P<0.05).Conclusions:The risk factors leading to the conversion of LPD to laparotomy include chronic pancreatitis,previous abdominal surgeries,pancreatic cancer,vascular resection and reconstruction.For patients with these risk factors,we should improve preoperative planning and prepare for conversion to laparotomy at any time.For high-risk LPD,when estimated operation time ?450min or EBL ?2000ml,conversion to laparotomy manifested a reduction effect on the mobidity,which is beneficial for patients to recovery.