What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations

Abstract

OBJECTIVE:Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy is still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decided to review the rate and causes of conversion from laparoscopic to open cholecystectomy.METHOD:This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from May 1999 to June 2010. The exclusion criteria were malignancy and/or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rate of conversion to open cholecystectomy, the underlying reasons for conversion, and postoperative complications were also analyzed.RESULTS:Of 5382 patients for whom LC was attempted, 5164 were included this study. The overall rate of conversion to open cholecystectomy was 3.16% (163 patients). There were 84 male and 79 female patients; the mean age was 52.04 years (range: 26–85). The conversion rates in male and female patients were 5.6% and 2.2%, respectively (p<0.001). The most common reasons for conversion were severe adhesions caused by tissue inflammation (97 patients) and fibrosis of Calot's triangle (12 patients). The overall postoperative morbidity rate was found to be 16.3% in patients who were converted to open surgery.CONCLUSION:Male gender was found to be the only statistically significant risk factor for conversion in our series. LC can be safely performed with a conversion rate of less than 5% in all patient groups.

Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: An Analysis in a High Risk Group of Patients

“…Conversion should not be considered a technical failure but, rather, accepted as a better surgical practice by the patient and surgeon when indicated [9].Carbon Dioxide and elevated intraabdominal pressure due to pneumoperitoneum has potential harmful intraoperative circulatory and Ventilatory effects are assumed to be deleterious for high risk patients ASA III & IV [10]. Despite the tremendous impact of Laparoscopic cholecystectomy on the management of biliary pathology, however surgeons continue to face challenges in application of Laparoscopic cholecystectomy in daily practice.…”

A comprehensive review of the factors predicting technical difficulty in laparoscopic cholecystectomy

“…Similar results were projected by Genc V et al where in their study, male gender was the only statistically significant risk factor among the various variables studied. 6 Studies by Nidoni et al, Vivek et al, Jethwani et al also found statistical significance in male sex as a risk factor for technical difficulty. 2,7,8 Other authors, though they accept male sex as a risk factor for conversion, could not consolidate it statistically.…”

“…Gholipour et al and Genc V et al found that intraoperative difficulty and rates of conversion were higher in patients who were operated in emergency those operated in the elective setup. 1,2,6,13 An interesting observation by Randhawa et al in his study states a palpable gallbladder as a significant predictor of intraoperative difficulty. 10 This was one of the unique predictive factor identified by the author.…”

“…9 Genc V et al and Randhawa et al did not find any statistical significance for previous abdominal surgery in prediction of difficult lap cholecystectomy. 6,10 This was attributed to experience of authors in adhesiolysis.…”

“…While Simopoulos et al and Constantini et al found the presence of diabetes as a statistically significant risk factor, Ibrahim S et al further elaborated by studying the safe levels of HbA1c in diabetic patients. 4,6,11 He found out that the risk of intraoperative difficulty and conversion was higher those diabetics with HbA1c levels more than 6%. Constantini et al also showed that a history of myocardial infarction has got a statistically significant risk of intraoperative procedure conversion in Laparoscopic cholecystectomy.…”