CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY - AN ANALYSIS OF RISK-FACTORS

Background: Identifying patients who are at risk for conversion from l aparoscopic (LC) to open cholecystectomy (OC) has proven to be difficu lt. The purpose of this review was to identify factors that may be pre dictive of cases which will require conversion to laparotomy for compl etion of cholecystectomy. Methods: We reviewed 581 LCs initiated betwe en July 1990 and August 1993 at a university medical center and record ed reasons for conversion to OC, Statistical analysis was then perform ed to identify factors predictive of increased risk for conversion, Re sults: Of the 581 LC initiated, 45 (8%) required OC for completion, Re asons for conversion included technical and mandatory reasons and equi pment failure, By multivariate analysis, statistically significant ris k factors for conversion included increasing age, acute cholecystitis, a history of previous upper abdominal surgery, and being a patient at the Veterans Affairs Medical Center (VAMC), Factors not increasing ri sk of conversion included gender and operating surgeon. Conclusions: W e conclude that no factor alone can reliably predict unsuccessful LC, but that combinations of increasing age, acute cholecystitis, previous upper abdominal surgery, and VAMC patient result in high conversion r ates. Patients with the defined risk factors may be counseled on the i ncreased likelihood of conversion, However, LC can be safely initiated for gallbladder removal with no excess morbidity or mortality should conversion be required.