Reasons and Risk Factors for Conversion from Laparoscopic to Open Cholecystectomy: A Retrospective Analysis in an Urban Teaching Hospital

Abstract

Introduction: Laparoscopic Cholecystectomy (LC), despite being the gold standard for the treatment of gallstone disease, requires conversion to Open Cholecystectomy (OC) at times for the safe and successful removal of Gallbladder. Inspite of various studies done on the topic, there are no accurate preoperative predictive factors for conversion. Aim: To analyse the most common predictive factors and reasons for conversion amongst patients, who underwent LC in an urban teaching hospital. Materials and Methods: A retrospective analysis was performed on 907 consecutive patients who underwent LC, from January 2017 till September 2018 in JSS Hospital, which is a tertiary care hospital. Recorded data were sex, age, indication for LC, conversion to OC, reason for conversion, comorbidity, type of complication, length of hospital stay and postoperative morbidity and mortality. The χ2 test and Independent t-test were used and all calculations were done using SPSS version 21.0. Results: Conversion from Laparoscopic to Open Cholecystectomy (LOC) was done in 17 (1.87%) out of the 907 cases. Dense adhesions between the gallbladder and the omentum/bowel (58.8%) and fibrosis of Calot’s triangle with distortion of anatomy (29.4%) were the most frequent reasons for conversion. It was also found that recent acute cholecystitis and presence of gall bladder perforation were independent predictive factors for conversion. Conclusion: The indications for conversion from LOC form a broad spectrum, ranging from more common ones like adhesions and fibrosis of Calot’s triangle to rare ones like Common Bile Duct (CBD) injury. The analysis of the predictive factors help in informing the patient about the added risk of conversion preoperatively

Keywords

• cholecystectomy conversion rate
• gall bladder perforation
• interval cholecystectomy
• preoperative prediction