Conversion in Laparoscopic Cholecystectomy in Low Versus High-volume Hospitals

Abstract

Contraindications to laparoscopic cholecystectomy (LC) have diminished over the last decade but still conversion rate is about 5% to 6% in elective cases and higher in acute cholecystitis. The aim of this study was to analyze whether the conversion rate is related to low (100 LC/y) versus high-volume hospitals (HVHs; >300 LC/y). From 1999 to 2004, operations were performed in a low-volume hospital (LVH) and a HVH, divided into 3 groups: primary open cholecystectomy (OC), LC, and conversion (CC). These groups were analyzed with regard to indications, intraoperative findings, reason for conversion, and postoperative complications, and compared between the 2 hospitals. In LVHs of the 550 patients who underwent cholecystectomy, 19 were OC (3.5%). Of the 531 patients who were started with laparoscopy, 5.3% (28 patients) were CC. In HVHs of the 1634 patients who underwent cholecystectomy, 82 were OC (5%). Of the 1552 patients who were started with laparoscopy, 5.8% (85 patients) were CC; P=0.7496. Dense adhesions (LVH 35.8% and HVH 37.6%, P=0.8544), severe cholecystitis (LVH 39.8% and HVH 34%, P=0.6199), and difficulties with the anatomy in Calot's triangle (LVH 7.2% and HVH 8.2%, P=0.8531) were the main reasons for conversion. There was no difference in the postoperative complication rate and reoperation rate between a LVH and a HVH. There is no difference in conversion rate in LC in LVHs versus HVHs. The quality of LC and even CC is similar in LVH and HVH.