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Published on: November 25, 2025
Timing of urgent laparoscopic cholecystectomy does not influence conversion rate
J S Knight1, S J Mercer, S S Somers
1Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
Insights
Urgent laparoscopic cholecystectomy for acute gallstone disease has a low conversion rate (12%) when performed by experienced surgeons. The timing of surgery does not impact conversion rates, challenging previous assumptions.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Acute gallstone disease management often involves urgent laparoscopic cholecystectomy.
- Existing literature suggests a potential increase in conversion rates with delays beyond 3-4 days.
- This study investigates the relationship between surgical timing and conversion rates.
Purpose of the Study:
- To assess the impact of surgical timing on conversion rates for laparoscopic cholecystectomy in acute gallstone disease.
- To evaluate the efficacy of a specialist-led protocol for urgent gallbladder surgery.
Main Methods:
- Prospective data collection over six months (March-August 2002).
- Analysis of 84 patients undergoing urgent laparoscopic cholecystectomy during their index admission.
- Comparison of conversion rates for procedures performed within and after 3 and 4 days of admission.
Main Results:
- Overall conversion rate was 12% (10 out of 84 patients).
- Conversion rates were similar for surgeries within 3 days (4/40) versus after 3 days (6/44).
- Conversion rates were also similar for surgeries within 4 days (5/46) versus after 4 days (5/38).
Conclusions:
- Urgent laparoscopic cholecystectomy can achieve low conversion rates (12%) under a specialist-led protocol with experienced surgeons.
- The timing of surgery for acute gallstone disease does not significantly affect the conversion rate.
- The study found no deaths and one common bile duct injury, indicating a safe procedure.
Background:
The optimal treatment of acute gallstone disease is urgent laparoscopic cholecystectomy, but there is confusion about the effect of delay in operation on conversion rates. Most reports suggest that delay beyond 3 or 4 days leads to a higher conversion rate. This study assessed the conversion rate in relation to the timing of laparoscopic surgery.
Methods:
This institution operates a specialist-led protocol for the urgent management of all admissions with acute gallstone disease. Data were collected prospectively over 6 months.
Results:
Between March and August 2002, 84 patients with acute gallstone disease underwent urgent laparoscopic cholecystectomy at the index admission with an overall conversion rate of 12 per cent. Four of 40 procedures carried out within 3 days of admission were converted, compared with six of 44 after 3 days. Five of 46 carried out within 4 days of admission were converted, compared with five of 38 after 4 days. There were no deaths and one common bile duct injury.
Conclusion:
As long as the procedure is carried out by experienced upper gastrointestinal surgeons working within a specialist-led protocol, the conversion rate for laparoscopic cholecystectomy can be as low as 12 per cent. The timing of urgent laparoscopic cholecystectomy has no impact on the conversion rate.