Predictive factors of conversion in laparoscopic cholecystectomy for acute calculous cholecystitis

Abstract

Purpose: Identify the predictive factors for conversion and to evaluate conversion’s impact on postoperative morbidity and mortality. Method: A retrospective study in the surgical department at Mongi Slim Hospital. We enrolled 300 patients who underwent LC for ACC between January 2015 and December 2018. Patients were divided into two groups: “Laparoscopy” for the 282 successful Laparoscopic cholecystectomies (LC) and “Conversion” for the 18 Convertions to open (CTO). A descriptive analysis of preoperative, intraoperative and postoperative data was performed, followed by a bivariate and a multivariate analysis comparing the two groups. The significance level was set at 0.05. Results: The conversion rate was 6%. The sex-ratio was 0.47. The median age was 50 years with interquartile range of 38-62 years. Bivariate analysis identified the following factors: male gender (p=0.001), age over 57 years (p=0.002), right upper quadrant tenderness (p=0.009), right upper quadrant guarding (p=0.006), leukocytosis ≥ 18000 cells /mL (p=0.002), leukopenia (<0.001), serum creatinine level > 20 mg/L (p=0.045), ultrasonographic findings like laminated gallbladder wall (p=0.033), pericholecystic abscess (p=0.045), liver abscess (p<0.001), intra-abdominal effusion (p=0.001), ACC grade II (p=0.009) and intraoperative findings like pericholecystic adhesions (p<0.001), gangrenous ACC (p=0.001), pericholecystic abscess (p=0.005), localized peritonitis (p=0.028), pediculitis (p=0.006), difficulties in identifying anatomical structures (p=0.014) and bile duct injuries (p<0.001). Multivariate analysis determined as predictive factors: male gender (OR=3.715; 95% CI [1.101-12.541]; p=0.03) and age over 57 years (OR=1.038; 95% CI [1-1.077]; p=0.04). There were no differences between the two groups in terms of postoperative morbidity and mortality. However, CTO was associated with a prolonged length of stay (p=0.02). Conclusion: The predictive factors of CTO are not modifiable. Their identification may help conduct a better communication with the patient and optimize the planning of the procedure.