Factors affecting conversion of laparoscopic cholecystectomy to open surgery.
OBJECTIVE
To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery.


METHODS
Demographic, ultrasonographic, and operative data of patients who underwent laparoscopic cholecystectomy were analyzed. Factors affecting conversion to open surgery were identified with statistical analysis.


METHODS
A tertiary referral center.


METHODS
Five hundred patients who underwent laparoscopic cholecystectomies at our institution between March 1991 and July 1994. The patients' data had been prospectively collected.


METHODS
Standard laparoscopic techniques with selective preoperative endoscopic retrograde cholangiopancreatography.


METHODS
Conversion of laparoscopic cholecystectomy to open surgery for management of technical difficulties or intraoperative complications.


RESULTS
Increased risk of conversion with statistical significance was found in patients older than 65 years, obese patients, patients who underwent interval elective laparoscopic cholecystectomy for acute cholecystitis, patients with ultrasonographic findings of thickened gallbladder wall, patients seen during the early learning phase of the series, and patients whose surgery was performed by senior surgeons. Increased risk of conversion was not found with patients' sex, previous lower abdominal surgery, history of acute pancreatitis or cholangitis, impaired liver function on presentation, or emergency laparoscopic cholecystectomy for acute cholecystitis.


CONCLUSIONS
Risk factors, including patient factors, presentation, preoperative ultrasonography, and surgical experience, all contributed to the possibility of conversion. Knowledge of these factors may help in arranging the operating schedule, psychological preparation for the procedure, and planning of the duration of convalescence.
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
C L
CL
Liu
S T
ST
Fan
E C
EC
Lai
C M
CM
Lo
K M
KM
Chu
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000601:surgery*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography