Can sonographic signs predict conversion of laparoscopic to open cholecystectomy?
BACKGROUND
The aim of this study was to determine whether sonographic signs can predict the risk for conversion of laparoscopic (LC) to open cholecystectomy (OC).


METHODS
All 346 patients who underwent LC at our institution between January 1, 1993, and March 1, 1996, were studied retrospectively. Patients who had no sonographic examination during 6 months prior to surgery and patients treated by inexperienced surgeons were excluded from the study. Patient characteristics and sonographic parameters were evaluated by univariate and multivariate analysis, using conversion to OC as a dependent variable.


RESULTS
In 23 of 134 patients (17.2%), LC was converted to OC. In the univariate analysis, gallbladder distention (>4.5 cm; relative risk [RR] 3.5; 95% confidence intervals [CI] 1.7-5.3), stone impaction (RR 2.4; 95% CI 1.1-5.1), thickened gallbladder wall (RR 2.4; 95% CI 1.2-5.1), and acute cholecystitis (RR 2.6; 95% CI 1.1-6.7) were able to predict the need for conversion. Logistic regression defined only the sonographic sign of distention of the gallbladder as a predictor of conversion.


CONCLUSIONS
Gallbladder distention as a sonographic sign is associated with a high relative risk for conversion. The predictive value of sonographic signs for conversion requires further assessment in a prospective study.
van der Velden
J J
JJ
Department of Radiology, University Hospital of Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Berger
M Y
MY
Bonjer
H J
HJ
Brakel
K
K
Laméris
J S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016001:Confidence Intervals; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography