Conversions in laparoscopic cholecystectomy in acute versus chronic cholecystitis

Early laparoscopic cholecystectomy imposes itself as an option of choice for treatment of acute cholecystitis, while the rate of conversions to open procedure represents a key parameter for evaluating the outcome.

The aim of this paper was to evaluate the results of the laparoscopic cholecystectomy in acute versus chronic cholecystitis through determining the conversion rate in open method, as well as to analye some predictive factors that may impact the decision to convert to open.

An analytical case control study was conducted at the University Clinic for Digestive Surgery in Skopje within a period of 27 months. The first group included 62 patients with acute cholecystitis on whom the laparoscopic cholecystectomy was performed in the period from zero to the seventh day from the onset of symptoms. The second group included 62 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy. Gender, age, history of cholecystitis, the time passed from the first symptoms till laparoscopic cholecystectomy and the duration of the intervention were analysed as factors that can possibly act on conversion.

There were no significant differences (p>0.05) between the group of patients with acute and the one with chronic cholecystitis due to conversion rate. In both groups, there was a significant difference in conversion due to the duration of the laparoscopic cholecystectomy (p<0.05), and in the group with acute cholecystitis also due to the time passed from the first symptoms till the laparoscopic intervention (p<0.01).

The rate of conversions can be reduced with a prompt approach to predictive factors.