Reasons and morbidity of conversions in laparoscopic cholecystectomy

ABSTRACT

To identify variables and morbidity that lead to conversion to open surgery in laparoscopic cholecystectomy [LC] patients. Descriptive case series. Surgical Department of Liaquat University Hospital Jamshoro, from June 2005 to May 2008. All patients with symptomatic cholelithiasis were included. Patients with previous abdominal surgery, gall stone cholangitis and pancreatitis were excluded. A total of 619 patients [68 males and 551 females] underwent laparoscopic cholecystectomy. Forty [6.46%] patients were converted to open surgery. Regarding preoperative variables males had higher conversion rate of 72.5%[p <0.0001]. Mean age of the converted group was 55.2 +/- 2.5 year and mean age of laparoscopic group was 42.6 +/- 3.8 year [p 0.0003]. Conversion was more in patients with acute cholecystitis [p value <0.0001]. Obscured anatomy of Calot's triangle [45%] and equipment failure [15%] were major reasons for conversion. Operative complications leading to conversion were bile duct injury [5%], haemorrhage [7.5%], duodenal injury [1%], colonic injury [1%] and common bile duct stones [5%]. Patients in conversion group had higher rate of postoperative morbidity. This included wound infection [10.0%], fever [12.5%], bile leakage [5%] and intra abdominal collection [5%]. It increased the hospital stay to 4.3 +/- 0.3 days which for the laparoscopic group was 1.6 +/- 0.1 day [p <0.0001]. Possibility of conversion can be predicted pre-operatively with variables like male gender, old age, acute cholecystitis and during surgery by obscured anatomy at Calot's triangle