A CLINICAL STUDY ON FACTORS CAUSING CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Abstract

Background: Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy mainly because of technical difficulty. Our aim was to determine the risk factors for the conversion. Methods: Preoperative clinical, laboratory, and radiologic parameters of 50 patients who underwent laparoscopic cholecystectomy were analyzed for their effect on conversion rates. Sixteen characteristics were evaluated including the following main characteristics for statistical analysis: Age, Sex, Body mass index, Pre-operative diagnosis, Total leucocyte count, Serum alkaline phosphatase, Serum albumin, Gall bladder wall thickness, Pericholecystic fluid, Per-operative indication for conversion. A constant and coefficients for these variables were calculated and formed the risk score. Results: On Multivariate Analysis female gender, elevated WBC Count, Ultrasound findings of pericholecystic fluid and thickened Gallbladder, and the presence of diabetes were independent predictors of conversion. All 5 factors were more frequently identified in patients who had a diagnosis of Acute Cholecystitis.
Conclusions: Conversion risk can be predicted easily by assessing the risk factors. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.