indications for conversion in laparoscopic cholecystectomy

ABSTRACT

To assess the indications of conversion in laparoscopic cholecystectomy [LC], regarding the critical time, age, gender, and severity of gallbladder inflammation. A retrospective study. Departments of Laparoscopic Surgery at AL-Salam and Al-Zahrawi Teaching Hospitals in Mosul. Four hundred patients with gallbladder pathology. The indications for conversion were evaluated. Retrospectively, patients in whom conversion to open cholecystectomy [OC] was needed were divided into two groups. The first included those where the surgeon felt unsafe to continue the procedure, while the second included those where a complication obliged the surgeon to convert the procedure to an open one. The study included 325 female and 75 male patients; their age range was 16 to 71 for females and 21 to 68 year for males. Eighty patients had acute cholecystitis of whom 15 patients had complicated form and 320 had chronic cholecystitis. Conversion to OC was needed in 30 patients [7.5%], 20 females and 10 males; 19 patients with acute and 11 patients with chronic cholecystitis. The first group included 24 patients; the indications were extensive adhesions, complicated gallbladder inflammation, and associated pathology. The second group included 6 patients. The explorations were needed because of uncontrolled bleeding, biliary tract injury and failure to induce safe insufflation. Conversion of LC to open procedure is a safe key which should be used whenever there is uncertainty about the safety of the procedure in order to avoid complication. Severe and complicated inflammation of the gallbladder and extensive adhesions are the most common indications for early conversion, while bleeding and biliary injury are the most frequent complications that necessitate conversion. Male sex and old age showed higher incidence of conversion