Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy is the gold standard in the treatment for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy for several factors. The objective of this study was to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy.


METHODS
One thousand two hundred and sixty-five laparoscopic cholecystectomies were carried out from January 2005 to January 2006 in our hospital. Preoperative clinical, laboratory and radiographic parameters of these patients were kept prospectively and analysed retrospectively.


RESULTS
Conversion to open cholecystectomy was needed in 94 patients (7.4%). The main reason for conversion was inability to safely display and identify anatomical structures of Calot's triangle correctly secondary to severe inflammation or dense adhesions, Multivariate analysis identified male sex, with Murphy's sign positive, gall bladder wall thickness > 4 mm and previous upper abdominal surgery as independent predictors of conversion rate to laparotomy.


CONCLUSIONS
Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors was important for understanding the characteristics of patients at a higher risk of conversion. Identifying risk factors will help the surgeon to plan and counsel the patients and introduce new policies.
Zhang
Wei-Jie
WJ
Department of General Surgery, 101th Hospital of People's Liberation Army, Wuxi, Jiangsu, China. mycool166@sina.com
Li
Jie-Ming
JM
Wu
Guo-Zhong
GZ
Luo
Kun-Lun
KL
Dong
Zhi-Tao
ZT
D002681:China / Q000453:epidemiology; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome