[Causes of unsuccessful attempts of laparoscopic cholecystectomy]

Based on an analysis of personal observations and literature data the authors made an analysis of the frequency and causes of unsuccessful laparoscopic cholecystectomy (LChE) resulting in laparotomy (conversion). LChE was successful in 217 of 233 operations. In 16 patients (6.9%) conversion was performed. According to the summary data of the literature on 150,000 cases of LChE the frequency of conversion was from 0.9 to 18%. The frequency of conversions was found to depend on the strategy of determining the indications for LChE and on the level of technological maintenance of operations. Three groups of the causes of conversion were set up on the basis of an analysis of publications about 498 cases of unsuccessful attempts of LChE and 16 personal observations: pathomorphological (393--78.9%; 7--43.8%); iatrogenic (99--19.9%; 7--43.8%) and technico-instrumental (6--1.2%; 2--12.4%). The pathomorphological causes lead to noncomplicated conversion and indicate to the limited use of LChE for the concrete patients. The iatrogenic and technico-instrumental causes appear all of a sudden and require emergent laparotomy. So the total frequency of conversion can not be a criterion for the assessment of complications after LChE. It is expedient to make a special analysis of the causes of transition to laparotomy and to distinguish the complicated and not complicated conversion.