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Risk factors for conversion of laparoscopic to open cholecystectomy.
Samer A Kanaan1, Kenric M Murayama, Louis T Merriam
1Northwestern University Medical School, Chicago, IL 60611, USA.
The Journal of Surgical Research
|July 20, 2002
Summary
Preoperative factors like older age, male gender, and cardiovascular disease increase the risk of converting laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). Acute cholecystitis also raises conversion rates but shouldn't prevent attempting LC.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Risk Stratification
Background:
- Laparoscopic cholecystectomy (LC) is standard for symptomatic gallstones.
- Conversion to open cholecystectomy (OC) is sometimes necessary.
- Preoperative predictors of LC to OC conversion remain unclear.
Purpose of the Study:
- Identify preoperative risk factors for LC to OC conversion.
- Improve patient counseling regarding conversion risk.
Main Methods:
- Retrospective review of 564 patients undergoing LC (1995-1996).
- Categorization into acute or chronic cholecystitis groups.
- Analysis of demographics, clinical data, and operative/pathology reports.
Main Results:
- 16/161 acute cholecystitis patients (10%) and 17/403 chronic cholecystitis patients (4%) were converted to OC.
- Conversion patients were older, more likely male, and had higher cardiovascular disease prevalence.
- Acute cholecystitis patients with higher leukocyte counts and gangrenous cholecystitis (29% conversion) showed increased conversion risk.
Conclusions:
- Older age, male gender, cardiovascular disease, and acute cholecystitis are key preoperative risk factors for LC to OC conversion.
- These factors allow for better patient risk assessment and informed consent.
- Despite increased rates, acute cholecystitis should not deter an attempt at LC.