title: Conversion cholecystectomy in patients with acute cholecystitis-it's not as black as it's painted!
abstract: BACKGROUND
  Although laparoscopic cholecystectomy is recommended as standard treatment for acute cholecystitis, in 10-30 % a conversion to open cholecystectomy is required. Among some surgeons, this is still perceived as a "complication." The aim of our study was to define characteristics and outcome of patients with acute cholecystitis undergoing conversion cholecystectomy.
  
  
  METHODS
  Over a 9-year period, 464 consecutive patients undergoing cholecystectomy for acute cholecystitis were analyzed for demographic, preoperative, intraoperative, histopathological, and laboratory findings and surgical outcome parameters.
  
  
  RESULTS
  Patients with conversion cholecystectomy were characterized by younger age, lower American Society of Anesthesiologists (ASA) score, and less cardiac comorbidities compared to patients with primary open cholecystectomy. Severity of inflammation on the clinical and histopathological level was similar and comparable. Overall complication rate, mortality, and median hospital stay were significantly lower compared to those of primary open cholecystectomy group.
  
  
  CONCLUSIONS
  There are no disadvantages for patients undergoing conversion cholecystectomy compared to primary open cholecystectomy. The outcome is influenced by general condition and comorbidities rather than by the surgical approach. Underlying fear of conversion should not avoid a laparoscopic approach in patients with acute cholecystitis.
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Spohnholz
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.affiliation: Institute of Pathology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Munding
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
authors.forename: Chris
authors.initials: C
authors.lastname: Braumann
authors.affiliation: Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany. a.chromik@klinikum-bochum.de.
authors.forename: Ansgar Michael
authors.identifier: http://orcid.org/0000-0002-4258-4644
authors.initials: AM
authors.lastname: Chromik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute cholecystitis; Cholelithiasis; Conversion cholecystectomy; Gallbladder; Laparoscopy