Predicting factors for conversion of laparoscopic cholecystectomy to open one

ABSTRACT

Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, certain cases still require conversion to open procedures. So, there is a need to identify risk factors for [a] predicting the probability of conversion preoperatively for selected patients, [b] preparing those patients psychologically, [c] arranging operating schedules accordingly, and [d] minimizing the procedure-related cost, which is a significant problem in developing countries. This study aimed to identify and evaluate risk factors that may predict conversion of laparoscopic cholecystectomy to an open procedure. 200 patients undergoing Laparoscopic cholecystectomy were included in the study. Sonographic findings like gall bladder wall thickness, adhesions around gall bladder and anatomy of Calot's triangle as well as gender, obesity, state of the liver and intra operative findings and/or complications which may supervene were analyzed. Of the 200 patients in whom laparoscopic cholecystectomy was attempted, 17 cases [8.5%] required conversion to open surgery. The most common reasons for conversion were dense adhesions around gall bladder [8cases] representing 47.05% of converted cases and 4% of total cases and gall bladder wall thickness>3mm [3 cases] accounting for 17.64% of total conversion and 1.5% of all cases .Significantly independent predictive factors for conversion were male gender, old age, obesity and liver cirrhosis. Patient factors, disease related factors, preoperative ultrasonography findings, operative findings and of no doubt surgeon's experience, all contribute to predict the possibility of conversion of laparoscopic cholecystectomy. Knowledge of these factors may help in pre-information to patient for psychological preparations for conversion and an experienced surgeon to operate on these patients