Risk factors for conversion to open surgery in laparoscopic cholecystectomy: A single center experience

This study aimed to demonstrate the demographic characteristics for laparoscopic cholecystectomy surgeries performed in the general surgery clinics of our hospital and to identify the rate of conversion to open surgery and the main reasons for convert to open surgery.

Medical records of a total of 1.294 patients who underwent laparoscopic cholecystectomy in our hospital between October 2013 and May 2017 were retrospectively reviewed, and the rates of conversion to open surgery based on age groups were recorded.

Of these patients, 1191 were females (92.0%) and 103 (7.9%) were males. Mean age was 48.6 ± 13.2 (range: 18 to 89) years. Indications for surgery were cholelithiasis in 1195 patients (92.4%), acute cholecystitis in 56 patients (4.4%), and gallbladder polyps in 43 patients (3.3%). The procedure was conversion to open surgery in 41 patients (3.16%), while 12 (0.9%) developed intraoperative complications. There was no mortality. Mean length of hospital stay was 1.2 (range: 1 to 6) days. The main reasons for conversation to open surgery were as follows: adhesions in the Calot's triangle (n= 3), acute cholecystitis (n= 29), choledocholithiasis (n= 2), adhesions due to previous surgery (n= 1), dissection difficulty (n= 2), organ damage (n= 2), anatomic variation (n= 1), and stone expulsion (n= 1).

Acute cholecystitis appears to be the significant factor increasing the rate of conversation to open surgery during LC procedures. Male sex and older age are the other factors increasing the risk of con- vert to open surgery. However, LC should be still the first choice of intervention.