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Risk factors for conversion to open surgery in patients with acute cholecystitis undergoing interval laparoscopic
Kok Ren Lim1, Salleh Ibrahim, Ngian Chye Tan
1Department of General Surgery, Changi General Hospital, Singapore. salleh_ibrahim@cgh.com.sg
Annals of the Academy of Medicine, Singapore
|September 4, 2007
Summary
Laparoscopic cholecystectomy for acute cholecystitis has a high conversion rate. Patient age, white cell count, bilirubin, alkaline phosphatase, and common bile duct stones predict conversion, aiding preoperative planning.
Area of Science:
- Surgical Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy for acute cholecystitis presents a higher conversion rate to laparotomy.
- Analysis of factors influencing conversion rates is crucial for surgical planning.
Purpose of the Study:
- To identify predictors of conversion from laparoscopic to open cholecystectomy in patients with acute cholecystitis.
Main Methods:
- Retrospective analysis of a prospective database of patients undergoing laparoscopic cholecystectomy between May 1998 and June 2004.
- Inclusion criteria: patients with acute cholecystitis undergoing interval laparoscopic cholecystectomy.
Main Results:
- Out of 201 patients with acute cholecystitis, 72.3% had successful laparoscopic cholecystectomy, while 27.7% required conversion to open surgery.
- Independent predictors of conversion included patient age (P=0.031), elevated white cell count (P=0.014), higher total bilirubin (P=0.002), increased alkaline phosphatase (P=0.003), and presence of common bile duct stones (P=0.001).
Conclusions:
- Laparoscopic cholecystectomy is a safe procedure for acute cholecystitis.
- Identifying preoperative predictors of conversion is valuable for surgical planning and patient counseling.
