Preoperative Risk Factors for Conversion from Laparoscopic to Open Cholecystectomy: A Systematic Review and Meta-Analysis

Abstract

Laparoscopic cholecystectomy is a standard treatment for patients with gallstones in the gallbladder. However, multiple risk factors affect the probability of conversion from laparoscopic cholecystectomy to open surgery. A greater understanding of the preoperative factors related to conversion is crucial to improve patient safety. In the present systematic review, we summarized the current knowledge about the main factors associated with conversion. Next, we carried out several meta-analyses to evaluate the impact of independent clinical risk factors on conversion rate. Male gender (OR = 1.907; 95%CI = 1.254–2.901), age > 60 years (OR = 4.324; 95%CI = 3.396–5.506), acute cholecystitis (OR = 5.475; 95%CI = 2.959–10.130), diabetes (OR = 2.576; 95%CI = 1.687–3.934), hypertension (OR = 1.931; 95%CI = 1.018–3.662), heart diseases (OR = 2.947; 95%CI = 1.047–8.296), obesity (OR = 2.228; 95%CI = 1.162–4.271), and previous upper abdominal surgery (OR = 3.301; 95%CI = 1.965–5.543) increased the probability of conversion. Our analysis of clinical factors suggested the presence of different preoperative conditions, which are non-modifiable but could be useful for planning the surgical scenario and improving the post-operatory phase.

Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study

“…The study included challenging cases and involved bile duct exploration. In another study, it was reported to range from 1 to 23.3%, underscoring the significance of training and sub-specialization (31). Emphasizing a high case volume and employing strategies such as subtotal cholecystectomy can help reduce CR.…”

Duplicated gallbladder with acute cholecystitis: a case of unusual presentation and diagnostic challenges

“…[12] Furthermore, the urgency of the patient's clinical condition may have factored into the surgeon's decision, leading them to conclude that an open surgical approach was the most prudent and efficacious course of action. The distinct presentation and anatomical variances of each patient should be considered while deciding between an open and a laparoscopic cholecystectomy [11,13] (Supplementary Table 1).…”

Association of severe obesity with risk of conversion to open in laparoscopic cholecystectomy for acute cholecystitis

“…Nevertheless, it remains necessary to identify patients at risk of having required unplanned conversion to open cholecystectomy. In conjunction with the pro-inflammatory state of obesity, the current analysis further identified increasing age and male sex to be associated with a higher likelihood of CTO [ 33 ]. While reasons for this are likely multifaceted, inflammation secondary to both age and male sex is a proposed factor [ 33 ].…”