title: Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallbladder disease. The identification of factors that reliably predict the likely need to convert LC to an open procedure would provide short-term benefits in terms of patient education and postoperative expectations.
  
  
  METHODS
  Between 1993 and 2004, 1179 elective LCs were attempted from a total of 1339 elective cholecystectomies. The change in conversion rate between 1993-1999 and 2000-2004 was analysed. Factors predictive of higher risk for conversion were also identified.
  
  
  RESULTS
  Eighty-nine LCs (7.5 per cent) required conversion. Gallbladder wall thickness and a history of common bile duct (CBD) stones, treated by preoperative endoscopic sphincterotomy, were predictors of conversion. The proportion of patients who underwent LC was the same in 1993-1999 (87.5 per cent) and 2000-2004 (88.8 per cent), but the conversion rate increased significantly from 5.3 to 10.6 per cent in these two time intervals. In addition, the proportion of patients with a history of CBD stones rose significantly, from 6.4 per cent in 1993-1999 to 11.0 per cent in 2000-2004.
  
  
  CONCLUSIONS
  The conversion rate increased over the 12-year interval of the study. A history of preoperative endoscopic sphincterotomy and a thickened gallbladder wall contributed to the likelihood of conversion.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. ishizaki@med.juntendo.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: K
authors.initials: K
authors.lastname: Miwa
authors.forename: J
authors.initials: J
authors.lastname: Yoshimoto
authors.forename: H
authors.initials: H
authors.lastname: Sugo
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods* / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data; D003657:Decision Making; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography