Laparoscopic to Open Cholecystectomy: The Risk Factors and the Reasons; A Retrospective Analysis of 1950 Cases of a...

We investigated the reasons, rates, and risk factors for the conversion to open cholecystectomies (CTOC) by statistical analysis with the demographic properties.

Demographic properties (age and sex), abdominal operations, and intraoperative and postoperative reasons for cholecystectomies were analyzed in 1950 patients.

The patients included 1540 (79%) women and 410 (21%) men (F/M=3.8); of these 115 (5.9%) had CTOC in early or late period. The rate of CTOC in men was significantly high (P= 0.009). There was no mortality. The reasons for CTOC were: significant inflammation (n=53, 46%), inadequate dissection of Calot triangle due to fibrotic adhesions (n=31, 27%), adhesions of previous surgery (n=9, 7.8%), uncontrollable bleeding (n=5, 4.3%), technical insufficiency (n=5, 4.3%), bile duct injury (n=5, 4.3%), anatomical variations (n=3, 2.6%), iatrogenic visceral injury (n=2, 1.7%), isolated right posterior bile duct injury (strasberg type-C) (n=1, 0.9%), and common hepatic duct partial injury (n=1, 0.9%).

Significant inflammation, inadequate dissection of Calot triangle due to fibrotic adhesions, and adhesions due to previous surgery were the 3 main reasons for conversion. Men and elderly patients were associated with significantly high rate of conversion.