title: A 14-year analysis of laparoscopic cholecystectomy: conversion--when and why?
abstract: BACKGROUND
  Contraindications to laparoscopic cholecystectomy diminished over the last decade but still conversion is about 5% to 6% in elective cases and higher in acute cholecystitis. The aim of this study was to analyze the reason for conversion in all patients operated on in our department and to create strategies for critical moments, which may need conversion.
  
  
  METHODS
  From 1990 to 2004, operations have been divided in 3 groups: primary open cholecystectomy (OC), laparoscopic cholecystectomy, and conversion. These groups were analyzed regarding the reason for conversion and postoperative complications.
  
  
  RESULTS
  Of the 5376 patients who underwent cholecystectomy, 327 had concomitant OC without further evaluation and 544 OC (11%). Of the 4505 patients (3159 women, 1346 men) who were all started by laparoscopy 5.4% [245 patients (123 women, 3.9%; 122 men, 9.1%; P<0.05)] were converted to OC. Acute cholecystitis (29.4%), difficulties with the anatomy in Calot's triangle (17.1%), and adhesions (14.3%) have been the main reasons for conversion beside difficulties in establishing pneumoperitoneum (3.7%).
  
  
  CONCLUSIONS
  The key scenes for conversion are the creation of the pneumoperitoneum, intra-abdominal adhesions, and difficulties in Calot's triangle, especially in acute cholecystitis. Conversion should not be seen as a complication.
authors: Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department, AKH Linz, Linz, Austria.
authors: Andreas
authors: A
authors: Shamiyeh
authors: Jan
authors: J
authors: Danis
authors: Wolfgang
authors: W
authors: Wayand
authors: Jörg
authors: J
authors: Zehetner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D041881:Cholecystitis, Acute / Q000601:surgery; D003135:Common Bile Duct / Q000293:injuries; D000075202:Contraindications; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial