[Laparoscopic cholecystectomy. An analysis of the reasons for a conversion to conventional surgery in an elective surgery department].
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.
Mattioli
F P
FP
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi, Genova.
Cagnazzo
A
A
Razzetta
F
F
Bianchi
C
C
Varaldo
E
E
Campagna
A
A
Percivale
A
A
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