REASONS FOR CONVERSION FROM LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY IN AN URBAN TEACHING HOSPITAL

BACKGROUND: Although laparoscopic cholecystectomy has replaced open ch olecystectomy for the majority of patients, it is clear that a substan tial minority will require laparotomy for safe and successful removal of the gallbladder. PATIENTS AND METHODS: Seven hundred forty-six lapa roscopic cholecystectomies performed at LAC+USC Medical Center from Ja nuary 1991 to May 1993 were retrospectively reviewed. Hospital stay, l aboratory values, and complications, as well as the need for and reaso n for conversion to open cholecystectomy were recorded. There were 661 females and 85 males, with a mean age of 38 years (range 15 to 92). R ESULTS: One hundred one (14%) of the 746 patients were converted to op en cholecystectomy. Difficult dissection secondary to inflammation or adhesions and the need to treat common-bile-duct stones were the most common reasons for conversion. Patients requiring conversion to open c holecystectomy were more likely to have been admitted through the emer gency department (72% versus 46%, P < 0.0001), have had prolonged hosp ital stays prior to surgery (mean time from admission to surgery 4.4 d ays versus 2.8 days, P < 0.0001), and to have had a thickened gallblad der wall on preoperative ultrasound (54% versus 20%, P < 0.001). CONCL USIONS: The most common reasons for conversion to open cholecystectomy are inflammation and adhesions secondary to severe acute and chronic disease and/or the need for clearance of the common bile duct. Patient s who were admitted to the emergency department, particularly if they were managed nonoperatively for a period of time and had a preoperativ e diagnosis of acute cholecystitis, were more likely to require conver sion to open cholecystectomy.