Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases. However, there is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is necessary.
A prospective study of 1000 such surgical procedures has now been conducted in an attempt to understand the risk factors that lead some patients to require such conversion.
| Inflamed contracted gallbladder:|
- most common reason for conversion.
The laparoscopic cholecystectomies were all carried out at the Ankara Numune Hospital in Ankara, Turkey, between March 1992 and July 1999, and included 804 women and 196 male patients, with an average age of 43.8 years (range, 30-80 years).
From the data collected, only factors available to the surgeon post-operatively were considered for analysis.
These factors included age, gender, history of acute cholecystitis, jaundice or pancreatitis, previous abdominal surgery, obesity and concomitant disease.
Also included as variables in the analysis were white blood cell count, preoperative liver function tests, ultrasound findings of the gall bladder, preoperative endoscopic retrograde cholangiopancreatography and suspicion of common bile duct stones.
The analysis also took into account the case numbers as a measure of institutional experience.
Of the 1,000 patients in whom laparoscopic cholecystectomy was attempted, 48 (5%) required conversion to open surgery.
The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 34).
Significantly independent predictive factors for conversion were male gender, previous abdominal surgery, acute cholecystitis, thickened gallbladder wall on preoperative ultrasonography, and suspicion of common bile duct stones.
The research team concludes from their findings that in the future, an appreciation of the aforementioned predictors of conversion will allow appropriate planning by the patient, the institution, and the surgeon.