Evaluation of Preoperative Risk Factor for Converting Laparoscopic to Open Cholecystectomy: A Meta-Analysis

Background/Aims: Laparoscopic cholecystectomy (LC) has become the gold standard for treating sy¬m¬ptomatic cholelithiasis. However, there are still some risk factors will lead to conversion to o¬p¬en cholecystectomy. The main aim of this meta-analysis is to evaluate preoperative risk fact¬o¬rs for converting laparoscopic to open cholecystectomy (LOC).

Evaluated risk factors of all clinical studies published from 1990 to 2012. All kinds of converting laparoscopic to open cholecystectomies were searched in the the Med-line, Embase, Science Citation Index, and PubMed databases. Random and fixed-effect models were used to aggregate the study endpoints and assess heterogeneity. The RevMan 5.2 was used for pooled estimates.

Eleven NRCTs containing 14645 patients (940 in the LOC group and 13705 in the LC group) were included in the present meta-analysis. From the pooled analyses, age > 65 years (OR = 1.83, 95% CI (1.31, 2.45), P < 0.0001), male gender (OR = 2.23, 95% CI (1.59, 3.12), P < 0.00001), Diabetes Mellitus (OR = 1.89, 95% CI (1.30, 2.75), P = 0.0009), acute cholecystitis (OR = 3.37, 95% CI (1.83, 6.20), P < 0.0001), thickened gallbladder wall (OR = 6.04, 95% CI (4.11, 8.88), P < 0.00001) and previous upper abdominal surgery (OR = 4.43, 95% CI (2.17, 9.04), P < 0.00001) were independent predictive risk factors for conversion. Previous lower abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and the gallstone pancreatitis were not significantly associated with conversion (all P > 0.05).

Our meta-analysis indicates that age > 65 years, male gender, acute cholecystitis, t¬hickened gallbladder wall, Diabetes Mellitus and previous upper abdominal surgery were sign¬i¬ficantly associated with increased risk of conversion. Evaluating these factors was useful for t¬h¬e doctors to make suitable operation scheme.