Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy (LC) has become the standard surgical procedure for symptomatic gallbladder disease. The aim of this study was to identify factors that may be predictive of cases that would require a conversion to laparotomy.


METHODS
In the period of 2002-2007, 2015 patients who underwent elective LC were included in the study. Patients were divided into two groups. Group 1 (n = 1914) consisted of patients whose operation was successfully completed with LC. Group 2 (n = 101) consisted of patients who had a conversion. A prospective analysis of parameters, including patient demographics, laboratory values, radiologic data, and intraoperative findings, was performed. Multivariate stepwise logistic regression was used to determine those variables predicting conversion.


RESULTS
One-hundred and one (5.0%) patients required a conversion. Significant predictors of conversion to open cholecystectomy in univariate analysis were increasing age, male gender, previous upper abdominal or upper plus lower abdominal incisions, an elevated white blood cell count, high aspartate transaminase, alkaline phosphatase and total bilirubin levels, preoperative ultrasound findings of a thickened gallbladder wall and dilated common bile duct, preoperative endoscopic retrograde cholangiopancreatography (ERCP), high-grade adhesion, and scleroatrophic appearance of the gallbladder intraoperatively. Multivariate analysis revealed that a history of previous abdominal surgery, preoperative ERCP, high-grade adhesion, and scleroatrophic appearance of the gallbladder predicted conversion.


CONCLUSIONS
Patient selection is very important for efficient, safe training in LC. Based on the presented data, pathways could be suggested that enable the surgeon to precisely decide, during LC, when to convert to open surgery.
Ercan
Metin
M
Department of Gastroenterological Surgery, Turkey Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey. metinercan66@mynet.com
Bostanci
E Birol
EB
Teke
Zafer
Z
Karaman
Kerem
K
Dalgic
Tahsin
T
Ulas
Murat
M
Ozer
Ilter
I
Ozogul
Yusuf B
YB
Atalay
Fuat
F
Akoglu
Musa
M
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors