CAN SONOGRAPHIC SIGNS PREDICT CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Background: The aim of this study was to determine whether sonographic signs can predict the risk for conversion of laparoscopic (LC) to ope n cholecystectomy (OC). Methods: All 346 patients who underwent LC at our institution between January 1, 1993, and March 1, 1996, were studi ed retrospectively. Patients who;had no sonographic examination during 6 months prior to surgery and patients treated by inexperienced surge ons were excluded from the study. Patient characteristics and sonograp hic parameters were evaluated by univariate and multivariate analysis, using conversion to OC as a dependent variable. Results: In 23 of 134 patients (17.2%), LC was converted to OC. In the univariate analysis, gallbladder distention (>4.5 cm; relative risk [RR] 3.5; 95% confiden ce intervals [CI] 1.7-5.3), stone impaction (RR 2.4; 95% CI 1.1-5.1), thickened gallbladder wall (RR 2.4; 95% CZ 1.2-5.1), and acute cholecy stitis (RR 2.6; 95% CI 1.1-6.7) were able to predict the need for conv ersion. Logistic regression defined only the sonographic sign of diste ntion of the gallbladder as a predictor of conversion. Conclusions: Ga llbladder distention as a sonographic sign is associated with a high r elative risk for conversion. The-predictive value of sonographic signs for conversion requires further assessment in a prospective study.