title: Conversion in laparoscopic cholecystectomy in low versus high-volume hospitals: is there a difference?
abstract: BACKGROUND
  Contraindications to laparoscopic cholecystectomy (LC) have diminished over the last decade but still conversion rate is about 5% to 6% in elective cases and higher in acute cholecystitis.
  
  
  OBJECTIVE
  The aim of this study was to analyze whether the conversion rate is related to low (100 LC/y) versus high-volume hospitals (HVHs; >300 LC/y).
  
  
  METHODS
  From 1999 to 2004, operations were performed in a low-volume hospital (LVH) and a HVH, divided into 3 groups: primary open cholecystectomy (OC), LC, and conversion (CC). These groups were analyzed with regard to indications, intraoperative findings, reason for conversion, and postoperative complications, and compared between the 2 hospitals.
  
  
  RESULTS
  In LVHs of the 550 patients who underwent cholecystectomy, 19 were OC (3.5%). Of the 531 patients who were started with laparoscopy, 5.3% (28 patients) were CC. In HVHs of the 1634 patients who underwent cholecystectomy, 82 were OC (5%). Of the 1552 patients who were started with laparoscopy, 5.8% (85 patients) were CC; P=0.7496. Dense adhesions (LVH 35.8% and HVH 37.6%, P=0.8544), severe cholecystitis (LVH 39.8% and HVH 34%, P=0.6199), and difficulties with the anatomy in Calot's triangle (LVH 7.2% and HVH 8.2%, P=0.8531) were the main reasons for conversion. There was no difference in the postoperative complication rate and reoperation rate between a LVH and a HVH.
  
  
  CONCLUSIONS
  There is no difference in conversion rate in LC in LVHs versus HVHs. The quality of LC and even CC is similar in LVH and HVH.
authors.affiliation: Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, AKH Linz, Austria. zehetner@hotmail.com
authors.forename: Jörg
authors.initials: J
authors.lastname: Zehetner
authors.forename: Stefan
authors.initials: S
authors.lastname: Leidl
authors.forename: Markus E
authors.initials: ME
authors.lastname: Wuttke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wayand
authors.forename: Andreas
authors.initials: A
authors.lastname: Shamiyeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006276:Health Facility Size; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult