Predicting Conversion From Laparoscopic to Open Cholecystectomy: A Prospective Risk Factor Analysis and Scoring Model...

Area of Science:

• General Surgery
• Surgical Outcomes
• Minimally Invasive Surgery

Background:

• Laparoscopic cholecystectomy (LC) is standard for gallstones, but conversion to open cholecystectomy (OC) occurs due to complications.
• Identifying risk factors for LC to OC conversion is vital for surgical planning and patient safety.

Purpose of the Study:

• To identify preoperative and intraoperative risk factors for LC to OC conversion.
• To develop a scoring system for predicting high-risk conversion cases.

Main Methods:

• Prospective observational study of 318 patients undergoing LC for symptomatic cholelithiasis.
• Analysis of preoperative (age, gender, comorbidities, prior surgery, lab markers) and intraoperative (gallbladder status, adhesions, Calot's triangle, CBD stones, fistula, critical view of safety) variables.
• Statistical analysis (P < 0.05) and development of a weighted risk scoring system.

Main Results:

• 10.38% (33/318) of patients required conversion to OC.
• Preoperative predictors: prior abdominal surgery (P=0.047) and elevated alkaline phosphatase (ALP) (P<0.001).
• Intraoperative predictors: contracted gallbladder, dense adhesions, non-visualization of Calot's triangle, failure to attain critical view of safety (CVS), CBD stones, and cholecystoenteric fistula (all P<0.001).

Conclusions:

• Conversion to OC, while infrequent, is essential for patient safety in challenging LC cases.
• Preoperative factors (prior surgery, elevated ALP) and specific intraoperative findings significantly predict conversion.
• The developed risk scoring system aids in early identification of high-risk patients, optimizing surgical planning and outcomes.