A Case-control Study On The Influential Factors Of Conversion To Laparotomy In Gynecological Laparoscopy Surgery

Objective:This study aims to analyze the causes and influencing factors leading to the conversion to laparotomy in gynecological laparoscopic surgery,and the findings of this paper are used to provide reference for the selection of appropriate surgical methods in clinical practice.Methods:A retrospective study was conducted,selecting 83 patients who underwent laparoscopic conversion to laparotomy in the gynecology department of Qingdao University Affiliated Hospital from August 2017 to August 2020.As a control group,166out of 16,203 patients who underwent laparoscopic surgery were selected using a 1:2 ratio based on matching parameters.It matched according to 4 parameters:age difference≤5years,surgery dates within 1 month,consistent preoperative diagnosis,and identical surgical procedures.All laparoscopic surgeries were graded,and factors leading to conversion to open surgery were observed.Clinical data such as age,body mass index(BMI),pregnancy and childbirth,history of endometriosis,history of pelvic inflammatory disease,history of pelvic tuberculosis,history of pelvic and abdominal surgery(cesarean section,myomectomy,oophorocystectomy,appendectomy,ectopic pregnancy surgery,tubal ligation,cholecystectomy),number of pelvic and abdominal surgery,anemia,blood transfusion,and pelvic adhesions were collected.Detailed review and analysis of medical records from the conversion to laparotomy group and the control group were conducted,followed by univariate analysis and conditional logistic regression analysis to explore the causes of laparotomy during gynecological laparoscopic surgery.Results:1.The rate of conversion to laparotomy in gynecological laparoscopy surgery was0.51%(83/16203).Among all conversion to laparotomy surgeries,Grade IV surgery accounted for the highest proportion at 54.2%(45/83),and the highest conversion rate to laparotomy surgery for Class IV surgery is 2.1%(45/2076),showing a statistically significant difference(P<0.001).2.The reasons for conversion to laparotomy in gynecological laparoscopy surgery:pelvic adhesions 50.6%(42/83),unexpected malignancy 18.1%(15/83),the tumor is too large or has a special shape or location 14.5%(12/83),hemostatic difficulty 7.2%(6/83),multiple uterine fibroids 3.6%(3/83),tumor metastasis need for simultaneous surgeries3.6%(3/83),bladder injury 1.2%(1/83),and occurrence of severe subcutaneous emphysema during surgery 1.2%(1/83).3.There were no significant differences in body mass index(BMI)and pelvic tuberculosis history between the two groups(all P>0.05).The patients in the conversion to laparotomy group had a history of endometriosis 37.3%(31/83),pelvic inflammatory disease 15.7%(13/83),and pelvic abdominal surgery history of 61.4%(51/83),which accounted for a higher proportion than that of the control group[21.1%(35/166),3.6%(6/166),30.7%(51/166)](χ~2=7.515,11.396,21.597,P=0.006,P=0.001,P<0.001).Among the types of surgical history,cesarean section37.3%(31/83),myomectomy19.3%(16/83),and oophorocystectomy 18.1%(15/83)had a higher proportion than the control group[25.3%(42/166),4.8%(8/166),3.0%(5/166)](χ~2=3.876,13.280,16.990,P=0.049,P<0.001,P<0.001).The number of pelvic and abdominal surgeries had a significant impact on the need for conversion to laparotomy,with statistically significant differences(all P<0.001).4.Conditional logistic regression analysis prompts:a history of pelvic inflammatory disease(OR=2.980,95%CI 1.052～8.441,P=0.040)and pelvic and abdominal surgical history(OR=3.330,95%CI 1.707～6.497,P<0.001)increased the risk of conversion to laparotomy.5.Compared with patients undergoing laparoscopic surgery,the perioperative indexes such as operation time(min),hospital stay(d),intraoperative bleeding(ml)and hospitalization cost(10,000 yuan)were longer(or more)in patients with conversion to laparotomy(all P<0.001).Conclusion:1.In this study,the rate of conversion to laparotomy was 0.51%in patients undergoing laparoscopic surgery in gynecologic surgery.2.Grade IV surgery was the most challenging,with the highest conversion rate of2.1%(45/2,076)and the highest proportion of all laparotomy surgeries at 54.2%(45/83).3.The primary factors leading to conversion to laparotomy in gynecological laparoscopic surgery were pelvic adhesions and unexpected malignancy.4.History of pelvic inflammatory disease and prior surgeries,including cesarean section,myomectomy,and ovarian cystectomy,were identified as risk factors for conversion to laparotomy in gynecological laparoscopic surgery.