LAPAROSCOPIC CHOLECYSTECTOMY - CAUSE OF CONVERSIONS IN 1,300 PATIENTSAND ANALYSIS OF RISK-FACTORS

In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 pati ents (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic reg ression analysis of 23 parameters identified the following data as ass ociated with a higher risk for conversion: pain or rigidity in the rig ht upper abdomen (P < 0.01), thickening of the gallbladder wall on pre operative ultrasound (P < 0.05), intraoperatively found dense adhesion s to the gallbladder or in Calot's triangle (P < 0.001), and intraoper atively found acute inflammation of the gallbladder (P < 0.01). Clinic al findings of an acute cholecystitis associated with intraoperative d ense scarring in Calot's triangle were the best factors predicting con version from LC to OC. As a result of the study we preoperatively sele ct our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complicatio ns low.