Preoperative factors predicting conversion from laparoscopic to open cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the treatment of gallbladder disease. However, certain cases still require conversion to open procedures. Conversion to OC can be predicted based on parameters available preoperatively. This study identified risk factors that may predict conversion from a laparoscopic to an open procedure. Patients and methods: From January 2007 to January 2010, a total of 130 laparoscopic cholecystectomies performed in our list were included in this prospective clinical study at Suez Canal University Hospitals. Patients were mostly females (71.5%) and age ranged from 23ys- 69ys with symptomatic GB stone disease. Analysis of many predictive parameters including; history, laboratory data, ultrasound results, and intraoperative details were performed. Multivariate logistic regression was used to determine those variables predicting conversion of LC to open OC during the procedure. Results: Laparoscopic cholecystectomy was converted into OC in 12.3% of the patients.The cause of conversion in this group was uncontrollable bleeding from injured cystic artery during difficult dissection in (37.5%), marked adhesions due to previous upper abdominal surgery (31.3%), inflamed thick GB wall (18.7%) and marked obesity (12.5%). Preoperative factors that can predict conversion from laparoscopic to OC are (in descending sort) elevated total leucocytic count (TLC) andfever(acute inflammation), pericholecysticfluid collection by US, elevated bilirubin, BMI > 35 Kgfm2, thickened GB wall, US positive Murphy's sign , previous upper abdominal surgery, low albumin, age >60years and ascites. Conclusion: In feverish morbidly obese patients with elevated TLC, thickened GB wall and/or pericholecystic fluid collection on US assessment with or without previous upper abdominal surgery, or low plasma albumin or mild jaundice (patients with one or more predictive factors), these patients should be subjected to LC by highly expert skillful team or may be the option of open cholecystectomy is the preferable from the start to lessen morbidity.