Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates

Abstract

This study demonstrated that, with specific strategies to decrease conversion and with technical improvements, the conversion rates can be decreased with no demonstrable difference in postoperative complications. Gallbladder wall thickness and increasing age are risk factors for conversion to open surgery.

Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

“…A thickened gallbladder wall was considered a significant risk in 9 of these studies [10,30,33,[35][36][37][40][41][42] . Meta-analysis on 3 of the studies [33,35,42] (n = 1,814, median NOS = 7 (range 7-8), I 2 = 0) found a pooled OR of 8.17 (95% CI 5.38-12.40; fig. 2 g), suggesting that a gallbladder wall thicker than 4-5 mm on preoperative ultrasound was a risk factor for conversion.…”

“…Older age was found to be a significant risk factor in 16 studies [8,11,25,27,30,32,34,36,[41][42][43][44][45][46]48] . Meta-analysis on 4 of these studies [33][34][35]39] (n = 2,820, median NOS = 8 (range 7-9), I 2 = 0%) found a pooled OR of 1.64 (95% CI 1.22-2.19; fig.…”

“…The cut-off values across the studies were 60 or 65 years. Two potential studies had to be excluded because they reported age as a continuous variable [5,42] . The quality of evidence for age as a risk factor was low using the GRADE approach, due to the observational nature of the studies.…”

Early versus delayed laparoscopic cholecystectomy with and without percutaneous drainage for complicated acute calculous cholecystitis: A prospective randomized study

“…There was no significant difference in conversion rate, mortality, morbidity and postoperative hospital stay between the three studied groups. In Low et al [22] the mean time from symptoms to surgery in patients who had successful ELC was 5.72 ±4.6 days and it was 5.83 ±1.73 days for patients who were converted to open procedure. Ohta et al [23] compared 4 timing groups of LC (72 hours, 4-14 days, 3-6weeks, and.6weeks after onset of symptoms) and found that the best timing for LC for acute cholecystitis is within 72 hours.…”

Laparoscopic Cholecystectomy: What is the Price of Conversion?

“…Despite improved surgical technology and increased surgical skills with laparoscopic technique, conversion rates of up to 10% continue to be reported. [7][8][9][10][11][12][13][14] Several patient-related factors have been identified that are associated with increased risk of conversion, including male gender and older age. 11,[15][16][17] Intraoperative factors, however, are the final determinant of why a surgeon converts a laparoscopic case to open.…”