Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Patient Outcomes

Background:

• Laparoscopic cholecystectomy (LC) is increasingly performed in outpatient settings.
• Conversion to open cholecystectomy (OC) is sometimes necessary.
• Predictive factors for LC to OC conversion require identification.

Purpose of the Study:

• To identify preoperative predictors of conversion from LC to OC.
• To aid in surgical planning for ambulatory or short-stay units.
• To facilitate comparison of data across different surgical series.

Main Methods:

• A single institutional study of 1,676 patients undergoing attempted LC.
• Evaluation of preoperative factors including patient demographics, medical history, lab tests, and imaging.
• Analysis of conversion rates to OC.

Main Results:

• Overall conversion rate was 5.4% (90/1,676).
• Significant predictors of conversion included acute cholecystitis, increasing age, male sex, obesity, and thickened gallbladder wall on ultrasound.
• Low conversion rate (1.9%) observed in nonobese women <65 years with biliary colic and normal gallbladder wall.

Conclusions:

• Preoperative factors can reliably predict the need for conversion from LC to OC.
• These predictors can optimize patient selection for outpatient LC and inform surgical unit planning.
• Identifying patients at high risk for conversion improves surgical resource allocation and patient safety.