P. Schrenk et al., LAPAROSCOPIC CHOLECYSTECTOMY - CAUSE OF CONVERSIONS IN 1,300 PATIENTSAND ANALYSIS OF RISK-FACTORS, Surgical endoscopy, 9(1), 1995, pp. 25-28
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.