Predictive factors for conversion of laparoscopic cholecystectomy to open cholecystectomy: a retrospective study

Abstract

Background:Laparoscopic cholecystectomy is the treatment of choice for symptomatic gall stones, though conversion to open cholecystectomy is a possibility. We have tried to estimate the risk factors which are associated with the conversion.

Methods: This retrospective study was conducted on 457 patients out of whom 38 were converted to open cholecystectomies. Patient’s records were analyzed and their demographic detail, physical and clinical examination details were taken into consideration. Details of the laboratory investigations were also noted.

Results:296 patients who underwent cholecystectomy were below the age of 60 years out of whom 9 had to be converted to open surgeries. 27 of 161 patients’ above the age of 60 years were converted to open cholecystectomy, showing the age is one of the risk factors for conversion. There were a significant number of patients who were at a risk of myocardial infarction or had a previous history of MI. Another significant comorbidity was previous surgery because of the presence of adhesions and acute cholecystitis. Tenderness in right hypochondriac region was seen in 76.8% of the converted cases while only 44% in the Laparoscopic cholecystectomy (LC) patients had tenderness. Gall bladder was also palpable in 36.8% of the converted patients and was the gall bladder thickness over 3mm was seen in 57.9% of the patients.

Conclusions:A thorough review of all the risk factors if performed based on the physical, clinical and laboratorial data, before the surgery in any setup, will help the surgeons to encounter the difficulty during LC and if required convert the surgery to open cholecystectomy.