Role of different factors as preoperative predictors of conversion of laparoscopic cholecystectomy to open cholecystectomy

Abstract

Aim: Laparoscopic cholecystectomy has become the gold standard for the treatment of gallstones. Background: The objective of our study was to identify the preoperative predictors of conversion of laparoscopic cholecystectomy into open cholecystectomy. Materials and Methods: We carried out a cross-sectional study in the Surgical Unit 1, Holy Family Hospital, Rawalpindi, from September 2016 to February 2017. All patients undergoing laparoscopic cholecystectomy were included in the study. Patients undergoing open cholecystectomy due to the presence of contraindication to laparoscopic cholecystectomy or patients in which laparoscopic cholecystectomy was a part of some other laparoscopic intervention were not included in the study. SPSS version 21 was used to analyze the data. Results: The overall mean age of the patients was 43.67 ± 13.54 years. The male patients were significantly older as compared to the female patients. The conversion rate was higher in patients who had an elevated total leukocyte count and alanine aminotransferase before the operation (P < 0.05). The rate of conversion was significantly higher in male patients aged ≥50 years (P < 0.05). Difficulty in the dissection of the triangle of Calot, difficulty in dissecting the gallbladder fossa, bleeding in gallbladder fossa, presence of duodenal fistula, and autolyzed gangrenous gallbladder were the reasons for the conversion to open cholecystectomy. Conclusion: The rate of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be 5%. Male patients aged ≥50 years, acalculous acute cholecystitis, acute cholecystitis, elevated preoperative total leukocyte count, and alanine aminotransferase levels were found to be significant predictors of conversion to open cholecystectomy.

Keywords

• Conversion
• gallbladder disease
• laparoscopic cholecystectomy
• male