title: Preoperative risk factors for conversion from laparoscopic to open cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstones. However, a conversion to open surgery is sometimes still required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in both elective and emergency cases.
  
  
  METHODS
  A retrospective review of all patients underwent laparoscopic cholecystectomy for symptomatic gallstones from January 2011 to October 2013 was performed. Data considered for analysis were: demographic data, comorbidities, preoperative laboratory values, preoperative ERCP, indication for surgery, and the timing of the intervention in acute cholecystitis. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.
  
  
  RESULTS
  414 patients underwent laparoscopic cholecystectomy. 245 were female (59.1%) and 169 (40.8%) male, with a mean age of 51.7±16.4 years. The indication for surgery was acute cholecystitis in 91 cases (21.9%). Lithiasis of the bile duct was found in 40 patients (9.6%), and it was identified preoperatively in 37 patients, all treated with a preoperative ERCP. Conversion to open occurred in 33 cases (7.9%). Univariate analysis revealed as risk factor for conversion: increased age, acute cholecystitis, comorbidities, elevated white blood cell count, increased level of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase, C-reactive protein, and fibrinogen. Multivariate logistic regression analysis showed that acute cholecystitis (OR 5.63) and age > 65 years (OR 3.025) were independent predictive factors for conversion.
  
  
  CONCLUSIONS
  These patients should be properly informed of their increased risk of conversion and should be operated by surgeons skilled in laparoscopic procedures to reduce this risk.
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advances Technologies, University of Catania, Catania, Italy. alessio.licciardello@hotmail.it.
authors.forename: A
authors.initials: A
authors.lastname: Licciardello
authors.forename: M
authors.initials: M
authors.lastname: Arena
authors.forename: A
authors.initials: A
authors.lastname: Nicosia
authors.forename: B
authors.initials: B
authors.lastname: Di Stefano
authors.forename: G
authors.initials: G
authors.lastname: Calì
authors.forename: G
authors.initials: G
authors.lastname: Arena
authors.forename: V
authors.initials: V
authors.lastname: Minutolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult