“Intraoperative reasons for conversion of laparoscopic cholecystectomy to open surgery systematic review” systematic review

Abstract

Conversion from laparoscopic cholecystectomy to open surgery is still very common. Prediction models have been advocated by many authors but there is a clear lack of investigations in the literature for unpredictable causes of conversion in minimally access cholecystectomy. The main purpose of the study is to define the unpredictable intraoperative reasons for conversion from laparoscopic cholecystectomy to open surgery. Three electronic databases were searched to identify the studies reporting intraoperative risk factors of conversion in laparoscopic cholecystectomy. The primary outcomes were to spot and specify the unpredictable risk factors and identify the most common intraoperative conversion causes. Secondary outcomes were comparing the impact of each group's reasons on conversion rate – patient-related factors, surgeon-related factors, and equipment-related and other factors of conversion. 22 studies were eligible for this review. We identified 13 different intraoperative patient-related, 11 surgeon-related, and 3 equipment-related risk factors of conversion. Dense adhesion around the gallbladder and Callot's triangle (27.6%, p value<0.001), unclear anatomy at Callot's triangle (24.3%, p value<0.001), and severe forms of inflammation like empyema and gangrene (13.5%, p value<0.001) were the most frequent causes of conversion. Bleeding (9.1%, p value<0.001) and bile duct injury (6.6%, p value<0.001) were far more popular for conversion than other factors made by surgeons. Intraoperative reasons for conversion are less investigated. Indeed, unpredictable findings and conditions in laparoscopic cholecystectomy are common and cause the conversion to open surgery very frequently. The quality of the studies reporting these factors is poor.