Factors affecting conversion of laparoscopic cholecystectomy to open surgery

Objective: To identify the risk factors predictive of conversion of laparoscopic cholecystectomy to open surgery. Design: Demographic, ultrasonographic, and operative data of patients who underwent laparoscopic cholecystectomy were analyzed. Factors affecting conversion to open surgery were identified with statistical analysis. Setting: A tertiary referral center. Patients: Five hundred patients who underwent laparoscopic cholecystectomies at our institution between March 1991 and July 1994. The patients' data had been prospectively collected. Intervention: Standard laparoscopic techniques with selective preoperative endoscopic retrograde cholangiopancreatography. Main Outcome Measure: Conversion of laparoscopic cholecystectomy to open surgery for management of technical difficulties or intraoperative complications. Results: Increased risk of conversion with statistical significance was found in patients older than 65 years, obese patients, patients who underwent interval elective laparoscopic cholecystectomy for acute cholecystitis, patients with ultrasonographic findings of thickened gallbladder wall, patients seen during the early learning phase of the series, and patients whose surgery was performed by senior surgeons. Increased risk of conversion was not found with patients' sex, previous lower abdominal surgery, history of acute pancreatitis or cholangitis, impaired liver function on presentation, or emergency laparoscopic cholecystectomy for acute cholecystitis. Conclusions: Risk factors, including patient factors, presentation, preoperative ultrasonography, and surgical experience, all contributed to the possibility of conversion. Knowledge of these factors may help in arranging the operating schedule, psychological preparation for the procedure, and planning of the duration of convalescence.