LAPAROSCOPIC CHOLECYSTECTOMY - DO PREOPERATIVE FACTORS PREDICT THE NEED TO CONVERT TO OPEN

We reviewed our experience with the last 587 laparoscopic cholecystect omies performed between May 1990 and January 1993 to correlate preoper ative findings that may predict the conversion of a laparoscopic chole cystectomy to that of an open procedure. The prediction of a need to c onvert to an open cholecystectomy would allow the surgeon to discuss t he higher risk of conversion with the patient and also allow for an ea rlier intraoperative decision to convert if difficulty was encountered . In addition to routine demographic data, ultrasound reports were ava ilable for 526 patients and the following information was recorded: pr esence of stones, thickened gallbladder wall, common bile duct dilatat ion, gallbladder sludge, and cystic duct impaction. Overall, a two tim es higher rate of conversion was found for male patients and patients with a body mass index >27.2 kg/m2. Additionally, a thickened gallblad der wall on preoperative ultrasound was correlated with a six times hi gher conversion rate to open cholecystectomy. As expected, the positiv e intraoperative cholangiogram was associated with a higher incidence of conversion. Additionally, finding a dilated common bile duct on ult rasound was found to be associated with a nearly seven times higher ra te of positive intraoperative cholangiogram. No statistical significan ce was found between conversion and age, previous abdominal operations , the presence of stones, common bile duct dilatation, gallbladder slu dge, cystic duct impaction, or a distended gallbladder. Thus, these pr edictive findings allow the surgeon to preoperatively discuss the high er risk of conversion and allow for an earlier judgment decision to co nvert if intraoperative difficulty is encountered.