title: Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery.
abstract: Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current  era of laparoscopic surgery. A retrospective review of medical records was undertaken to identify all laparoscopic converted to open cholecystectomy performed at a single center over a 2-year period. Reasons for conversion, surgeon's preoperative indications, and specimen pathologic results  were documented. A review of published data from the previous two decades was also conducted for comparison of contemporary versus historical reasons for intraoperative conversion. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital  System University Medical Center. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. A diagnosis of acute cholecystitis (58.8%) was more common among converted cases. Inflammation (35%), adhesions (28%), and anatomic difficulty (22%) were the three  most common intraoperative findings leading to conversion. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management  of this condition. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation.
authors.affiliation: Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina, USA. vle@ghs.org
authors.forename: Viet H
authors.initials: VH
authors.lastname: Le
authors.forename: Dane E
authors.initials: DE
authors.lastname: Smith
authors.forename: Brent L
authors.initials: BL
authors.lastname: Johnson
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome