title: Risk factors for conversion during laparoscopic cholecystectomy: retrospective analysis of ten years' experience at a single tertiary referral centre.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic benign gallbladder disease. The identification of factors that reliably predict the need to convert LC to open cholecystectomy (OC) would help with patient education and counseling.
  
  
  METHODS
  Between January 2000 and December 2009, 4,698 patients underwent cholecystectomy. LC was attempted in 4,434 patients (94.4%) and OC from the start was performed in 264 patients (5.6%). The causes for conversion were evaluated. The change in conversion rate between 2000 and 2004 and between 2005 and 2009 was analyzed. Factors predictive of conversion were identified by univariate and multivariate analysis.
  
  
  RESULTS
  Conversion to OC from an initial LC approach was required in 234 patients (5.3%). The main cause for conversion was dense adhesions (54.7%). Independent risk factors in multivariate analysis were male gender (p < 0.001), increased age (p < 0.001), a history of previous upper abdominal surgery (p < 0.001), a WBC count >9 × 10(3)/μl, and urgently indicated cholecystectomy (p <0.001). The conversion rate decreased significantly from 6.7 to 3.6% over the two time intervals (p < 0.001).
  
  
  CONCLUSIONS
  Those at highest risk for conversion are elderly male patients with prior abdominal surgery who present emergently with laboratory evidence of biliary inflammation.
authors: Gastroenterology Surgical Center, Surgery Department, Mansoura University, Mansoura, Egypt.
authors: Ahmad M
authors: AM
authors: Sultan
authors: Ayman
authors: A
authors: El Nakeeb
authors: Talaat
authors: T
authors: Elshehawy
authors: Mohamed
authors: M
authors: Elhemmaly
authors: Ehab
authors: E
authors: Elhanafy
authors: Ehab
authors: E
authors: Atef
mesh_terms: D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome