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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
Introduction:
Laparoscopic cholecystectomy for acute cholecystitis is associated with higher rate of conversion to laparotomy. The value of several factors that might influence the rate of conversion is analysed.
Materials And Methods:
In a retrospective analysis of a prospective database, the medical records of patients who underwent laparoscopic cholecystectomy from May 1998 to June 2004 were reviewed. Patients who had acute cholecystitis and had undergone interval laparoscopic cholecystectomy were included in this study.
Results:
Out of 1000 laparoscopic cholecystectomies, 201 were operated on for acute cholecystitis. One hundred and forty-five patients (72.3%) underwent successful laparoscopic cholecystectomy and 56 patients (27.7%) needed conversion to open cholecystectomy. Patient's age (P = 0.031), total white cell count (P = 0.014), total bilirubin (P = 0.002), alkaline phosphatase (P = 0.003) and presence of common bile duct stone (P = 0.001) were found to be independently associated with conversion.
Conclusion:
Laparoscopic cholecystectomy can be performed safely for acute cholecystitis. Predictors of conversion will be helpful when planning the laparoscopic approach and for counselling patients preoperatively.
