Factors affecting conversion of laparoscopic cholecystectomy to open surgery
C. L. Liu, S. T. Fan, E. C. Lai, C. M. Lo and K. M. Chu
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
OBJECTIVE: To identify the risk factors predictive of conversion of
laparoscopic cholecystectomy to open surgery. DESIGN: Demographic,
ultrasonographic, and operative data of patients who underwent laparoscopic
cholecystectomy were analyzed. Factors affecting conversion to open surgery
were identified with statistical analysis. SETTING: A tertiary referral
center. PATIENTS: Five hundred patients who underwent laparoscopic
cholecystectomies at our institution between March 1991 and July 1994. The
patients' data had been prospectively collected. INTERVENTION: Standard
laparoscopic techniques with selective preoperative endoscopic retrograde
cholangiopancreatography. MAIN OUTCOME MEASURE: Conversion of laparoscopic
cholecystectomy to open surgery for management of technical difficulties or
intraoperative complications. RESULTS: Increased risk of conversion with
statistical significance was found in patients older than 65 years, obese
patients, patients who underwent interval elective laparoscopic
cholecystectomy for acute cholecystitis, patients with ultrasonographic
findings of thickened gallbladder wall, patients seen during the early
learning phase of the series, and patients whose surgery was performed by
senior surgeons. Increased risk of conversion was not found with patients'
sex, previous lower abdominal surgery, history of acute pancreatitis or
cholangitis, impaired liver function on presentation, or emergency
laparoscopic cholecystectomy for acute cholecystitis. CONCLUSIONS: Risk
factors, including patient factors, presentation, preoperative
ultrasonography, and surgical experience, all contributed to the
possibility of conversion. Knowledge of these factors may help in arranging
the operating schedule, psychological preparation for the procedure, and
planning of the duration of convalescence.
