Abstract
Background. There is an increased use of laparoscopic cholecystectomy (LC) but some
patients still require conversion to open cholecystectomy (OC) because of preoperative risk
factors or operative findings. The aim of this study was to evaluate risk factors responsible
for conversion and accordingly to decide the more suitable procedure for each patient
preoperatively and when to convert intraoperatively.
Patients and methods. The records of patients, who underwent elective
cholecystectomy from January 2008 to December 2011, were reviewed prospectively. The
demographics preoperative and operative data of patients who required conversion to OC
were compared to those with successful LC and analyzed.
Results. A total of 450 patients underwent LC were included in this study, conversion to
OC was required in 36 patients (8%). Male patients (p=<0.001), patients aged ≥60 years
(p=<0.001), patients with a history of frequent attacks of acute cholecystitis (AC)
(p=<0.001), and patients with a thickened gall bladder (GB) wall on ultrasonography (US) (>
4 mm) (p=<0.001) were all significantly associated with an increased conversion rate while
obesity, right hypochondrial tenderness on physical examination, previous abdominal
operations and leucocytosis were all nonsignificant.
Also, the operative findings in patients who required conversion to OC were as following; 13
cases (36.1%) were due to the presence of adhesions making dissection and delineating the
anatomy difficult, AC in 12 (33.3%) due to adhesions and bleeding during dissection which
masks the anatomy, uncontrollable bleeding in 5 (13.9%), suspected common bile duct
(CBD) injuries in 3 cases (8.3%), aberrant anatomy in 2 (5.6%), and lastly according to the
anesthetist request in one case (2.8%). All were correlated with an increased conversion rate
to OC.
Conclusion. Risk factors for conversion help to consider difficulty of LC and permit
surgeon to inform patients about the risk of conversion or even selection of OC from the start
and for early decision of conversion to OC for better outcome.