Although laparoscopic cholecystectomy has replaced open cholecystectomy for the treatment of gallbladder disease, certain cases still require conversion to open procedures.
Identifying those patients at risk for conversion is difficult.
In this study, researchers from Cleveland, USA, determined the risk factors that predict conversion from a laparoscopic procedure to an open procedure.
Data from a total of 1347 laparoscopic cholecystectomies performed at the Cleveland Clinic Foundation, between 1996 and 2000, were examined.
The research team retrospectively analyzed 34 parameters, including patient demographics, clinical history, laboratory data, ultrasound results, and intraoperative details.
Stepwise, multivariate logistic regression was used to determine the variables predicting the conversion of laparoscopic cholecystectomy.
In this study, 5% of laparoscopic cholecystectomies required conversion.
| Body mass predicts conversion in patients with acute cholecystitis.|
|American Journal of Surgery|
Multivariate analysis revealed that for all cases, a white blood cell count greater than 9 (odds ratio 2.9) and a gallbladder wall thickness greater than 0.4 cm (odds ratio 7.2) predicted conversion to open cholecystectomy.
However, when patients with acute cholecystitis were evaluated, only a body mass index greater than 30kg/m2 (odds ration 5.6) predicted conversion.
For patients undergoing elective cholecystectomy, a body mass index greater than 40kg/m2 (odds ratio 33.1) and a wall thickness greater than 0.4 cm (odds ratio 24.7) predicted conversion.
Finally, an ASA greater than 2 (odds ratio 5.3) predicted conversion in those patients undergoing nonelective cholecystectomies.
Dr Michael Rosen said on behalf of his team, "Obese patients with acute cholecystitis undergoing laparoscopic cholecystectomy have an increased chance of conversion.
"Additionally, patients with multiple comorbid diseases undergoing nonelective laparoscopic cholecystectomy are more likely to require conversion.
"Finally, in an elective laparoscopic cholecystectomy, morbidly obese patients with chronic cholecystitis and a thickened gallbladder wall are more likely to require conversion."
"These factors can help counsel patients undergoing laparoscopic cholecystectomy with regards to the probability of conversion to an open procedure", he concluded.