Korean J Hepatobiliary Pancreat Surg.  2008 Sep;12(3):168-172.

Comparative Clinical Analysis of 111 Laparoscopic Cholecystectomy Cases Converted to Open Procedures

Affiliations
  • 1Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea. ushinchoi@hotmail.com

Abstract

PURPOSE: While laparoscopic cholecystectomy can be successfully performed in the majority of patients, conversion to open procedure is still necessary in certain cases. The purpose of this study was to identify the discerning factors that helped to predict the need for conversion to open cholecystectomy.
METHODS
A retrospective review was conducted on the data for 2,523 laparoscopic cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July 2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for conversion to open procedure were evaluated.
RESULTS
Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the risk of conversion on univariate analysis were patient age >70 years, male sex, previous abdominal operation, preoperative common bile duct stone, tenderness in the right upper quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate analysis, the following factors were found to be associated with a higher risk: patient age >70 years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and preoperative common bile duct stone (p=0.041).
CONCLUSION
In the case of operations with such discerning factors, surgeons should be more cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce the risk of additional severe complications, surgeons need to decide early on if they will perform a conversion.

Keyword

Laparoscopic cholecystectomy; Conversion risk factors

MeSH Terms

Bile Ducts
Body Weight
Cholecystectomy, Laparoscopic
Common Bile Duct
Gallbladder
Hemorrhage
Humans
Incidence
Inflammation
Length of Stay
Male
Multivariate Analysis
Physical Examination
Retrospective Studies
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