title: [Laparoscopic cholecystectomy. An analysis of the reasons for a conversion to conventional surgery in an elective surgery department].
abstract: BACKGROUND
  To assess which factors determined conversion to laparotomy in patients undergoing laparoscopic elective cholecystectomy.
  
  
  METHODS
  department of General Surgery. University of Genoa. Italy.
  
  
  METHODS
  Two hundred sixty-four consecutive laparoscopic cholecystectomies were performed in our Department.
  
  
  METHODS
  laparoscopic cholecystectomy was performed according to Dubois's technique. Duration of the procedure was not considered a reason for conversion.
  
  
  RESULTS
  121 patients showed "difficult intraoperative situations" with further conversion risk factor. Conversion to laparotomy was necessary in 11 patients (4.16%). Five patients underwent conversion in the first 50 cases (10%), while six in the last 214 (2.8%). We had to convert to open cholecystectomy only in eleven patients, despite the high rate of technical difficulties and anatomic anomalies even in cases which, in the past, represented a contraindication to this kind of technique. The use of new instruments and new surgical techniques has reduced to only factors of increased risk in those situations that in the past were considered as contraindications to laparoscopic cholecystectomy.
  
  
  CONCLUSIONS
  Conversion to open cholecystectomy is based on the surgeon's decision and the safety should be the main consideration in performing laparoscopic cholecystectomy. The use of a careful dissection could avoid the conversion in many patients.
authors.affiliation: Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi, Genova.
authors.forename: F P
authors.initials: FP
authors.lastname: Mattioli
authors.forename: A
authors.initials: A
authors.lastname: Cagnazzo
authors.forename: F
authors.initials: F
authors.lastname: Razzetta
authors.forename: C
authors.initials: C
authors.lastname: Bianchi
authors.forename: E
authors.initials: E
authors.lastname: Varaldo
authors.forename: A
authors.initials: A
authors.lastname: Campagna
authors.forename: A
authors.initials: A
authors.lastname: Percivale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D020535:Video-Assisted Surgery