Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy is the gold standard treatment for most gallbladder diseases. Conversion to open cholecystectomy is necessary in some patients for any of a number of factors. Identifying these factors will help the patient, the surgeon, and the hospital.


METHODS
One thousand laparoscopic cholecystectomies were performed from May 1998 to May 2004 in Changi General Hospital, Singapore; 103 patients (10.3%) required conversion to open cholecystectomy. All data were kept prospectively and analyzed retrospectively.


RESULTS
The patients who had conversion were mostly men (P < 0.0001), were heavier (P < 0.05), had acute cholecystitis (P < 0.0001), and had a history of upper abdominal surgery (P < 0.001). There were no differences in terms of race (P = 0.315) and presence of diabetes mellitus (P = 0.126). Diabetic patients who had conversion had a significantly higher glycosylated hemoglobin (Hba1c) (8.9% +/- 0.6%; P < 0.038). Patients who had conversion had a higher total white count (P < 0.05), but liver function tests were similar between the two groups. There was a higher conversion rate among the junior surgeons than the more experience surgeons (P < 0.032).


CONCLUSIONS
The significant risk factors for conversion were male gender, advanced age (> 60 years), higher body weight > 65 kg, acute cholecystitis, previous upper abdominal surgery, junior surgeons, and diabetes associated with Hba1c > 6. Chronic liver disease was not found to be a risk factor (P = 0.345), and performing laparoscopic cholecystectomy in cirrhotic patients is safe. Identifying risk factors will help the surgeon to plan and counsel the patient and introduce new policies to the unit. Some of the risk factors are similar to those reported from international centers, but others may be unique to our department.
Ibrahim
Salleh
S
Department of Surgery, Changi General Hospital, 2nd Simei Street 3, Singapore 529889. salleh_ibrahim@cgh.com.sg
Hean
Tay Khoon
TK
Ho
Lim Swee
LS
Ravintharan
T
T
Chye
Tan Ngian
TN
Chee
Chng Hong
CH
D000328:Adult; D002763:Cholecystectomy / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D041761:Cholecystolithiasis / Q000453:epidemiology / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors