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Laparoscopic cholecystectomy. Cause of conversions in 1,300 patients and analysis of risk factors
P Schrenk1, R Woisetschläger, W U Wayand
1Second Surgical Unit, AKH Linz, Austria.
Insights
Laparoscopic cholecystectomy (LC) conversion to open cholecystectomy (OC) occurred in 4.3% of patients. Preoperative ultrasound findings and intraoperative adhesions or inflammation best predict the need for conversion.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Laparoscopic cholecystectomy (LC) is a common procedure for gallstones.
- Conversion to open cholecystectomy (OC) may be necessary due to intraoperative findings.
- Predicting conversion risk is crucial for patient management.
Purpose of the Study:
- To identify risk factors for conversion from LC to OC.
- To analyze the causes of conversion.
- To improve patient selection and surgical strategy.
Main Methods:
- Retrospective analysis of 1,300 patients undergoing LC.
- Logistic regression analysis of 23 preoperative and intraoperative parameters.
- Comparison of elective versus enforced conversions.
Main Results:
- 56 patients (4.3%) required conversion to OC.
- Predictive factors for conversion included right upper abdominal pain/rigidity, thickened gallbladder wall on ultrasound, dense adhesions, and acute gallbladder inflammation.
- Acute cholecystitis with dense scarring in Calot's triangle were strong predictors.
Conclusions:
- Preoperative patient selection and surgeon experience are key to minimizing conversion rates.
- Identifying high-risk patients allows for better surgical planning and potentially upfront OC.
- Optimizing surgical strategy reduces complications associated with LC to OC conversion.
Abstract:
In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 patients (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic regression analysis of 23 parameters identified the following data as associated with a higher risk for conversion: pain or rigidity in the right upper abdomen (P < 0.01), thickening of the gallbladder wall on preoperative ultrasound (P < 0.05), intraoperatively found dense adhesions to the gallbladder or in Calot's triangle (P < 0.001), and intraoperatively found acute inflammation of the gallbladder (P < 0.01). Clinical findings of an acute cholecystitis associated with intraoperative dense scarring in Calot's triangle were the best factors predicting conversion from LC to OC. As a result of the study we preoperatively select our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complications low.