Laparoscopic Cholecystectomy: What is the Price of Conversion?

Lengyel, Balazs I.; Ashley, Stanley W.; Panizales, Maria Theresa P.; Steinberg, John B.; Tavakkolizadeh, Ali

doi:10.1016/j.jss.2010.11.604

Cited by 11 publications

(13 citation statements)

References 31 publications

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“…3 However, current literature suggests that the rate of intraoperative conversion from LC to OC is 1%e15%, 4e6 and that conversion is known to increase perioperative time, complication rates, perioperative costs, the length of hospital stay, and hospital charges. 7,8 Conversion is also associated with complications including death, bile duct injury, bile leak, or bleeding, requiring reoperation or transfusion. 9 It is, therefore, essential to identify risk factors for conversion to allow for safer procedures and better surgical planning.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Menon

Gunnarsson

et al. 2017

The American Journal of Surgery

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Section: Introductionmentioning

confidence: 99%

Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Menon

Gunnarsson

et al. 2017

The American Journal of Surgery

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“…Conversion of laparoscopic procedures has significant consequences for patients in terms of postoperative pain, hospital charges, and duration of inpatient stay. 41 Surgeons need to be aware of the risk factors for LCO and should be prepared to discuss the likelihood of conversion with patients with reasonable specificity, particularly when obtaining consent from patients at increased risk. Preoperative identification of patients at particularly high risk for LCO could also alter the surgeon's approach intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Conversion from Laparoscopic to Open Surgery: Analysis of 2138 Converted Operations in the American College of Surgeons National Surgical Quality Improvement Program

Papandria

Lardaro

Rhee

et al. 2013

The American Surgeon

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Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n = 1526 [1.9%]) and LCO bariatric procedures were less likely (n = 121 [0.3%]); appendectomy was intermediate (n = 491 [1.0%], P < 0.001). Patient factors associated with LCO included male sex ( P < 0.001), age 30 years or older ( P < 0.025), American Society of Anesthesiologists Class 2 to 4 ( P < 0.001), obesity ( P < 0.01), history of bleeding disorder ( P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis ( P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room ( P < 0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients.

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“…open cholecystectomy (OC) may be resorted to for various reasons with reported rates of 1% to 15% [2,3]. Open conversion increases the operative time, complication rates, perioperative costs and the length of hospital stay [4][5][6].…”

Section: Conversion From Laparoscopic Cholecystectomy (Lc) Tomentioning

confidence: 99%

Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates

Nassar

Zanati

et al. 2021

Surg Endosc

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Background Open conversion rates during laparoscopic cholecystectomy vary depending on many factors. Surgeon experience and operative difficulty influence the decision to convert on the grounds of patient safety but occasionally due to technical factors. We aim to evaluate the difficulties leading to conversion, the strategies used to minimise this event and how subspecialisation influenced conversion rates over time. Methods Prospectively collected data from 5738 laparoscopic cholecystectomies performed by a single surgeon over 28 years was analysed. Routine intraoperative cholangiography and common bile duct exploration when indicated are utilised. Patients undergoing conversion, fundus first dissection or subtotal cholecystectomy were identified and the causes and outcomes compared to those in the literature. Results 28 patients underwent conversion to open cholecystectomy (0.49%). Morbidity was relatively high (33%). 16 of the 28 patients (57%) had undergone bile duct exploration. The most common causes of conversion in our series were dense adhesions (9/28, 32%) and impacted bile duct stones (7/28, 25%). 173 patients underwent fundus first cholecystectomy (FFC) (3%) and 6 subtotal cholecystectomy (0.1%). Morbidity was 17.3% for the FFC and no complications were encountered in the subtotal cholecystectomy patients. These salvage techniques have reduced our conversion rate from a potential 3.5% to 0.49%. Conclusion Although open conversion should not be seen as a failure, it carries a high morbidity and should only be performed when other strategies have failed. Subspecialisation and a high emergency case volume together with FFC and subtotal cholecystectomy as salvage strategies can reduce conversion and its morbidity in difficult cholecystectomies.

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Laparoscopic Cholecystectomy: What is the Price of Conversion?

Cited by 11 publications

References 31 publications

Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Risk factors for conversion of laparoscopic cholecystectomy to open surgery – A systematic literature review of 30 studies

Risk Factors for Conversion from Laparoscopic to Open Surgery: Analysis of 2138 Converted Operations in the American College of Surgeons National Surgical Quality Improvement Program

Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates

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