Predictive factors for conversion of laparoscopic cholecystectomy

doi:10.1016/S0002-9610(02)00934-0

The American Journal of Surgery

Volume 184, Issue 3, September 2002, Pages 254-258

https://doi.org/10.1016/S0002-9610(02)00934-0 Get rights and content

Abstract

Background: Laparoscopic cholecystectomy has replaced open cholecystectomy for the treatment of gallbladder disease. However, certain cases still require conversion to open procedures. Identifying these patients at risk for conversion remains difficult. This study identifies risk factors that may predict conversion from a laparoscopic to an open procedure.

Methods: From January 1996 to January 2000, a total of 1,347 laparoscopic cholecystectomies were performed at the Cleveland Clinic Foundation (CCF). A retrospective analysis of 34 parameters including patient demographics, clinical history, laboratory data, ultrasound results, and intraoperative details was performed. Stepwise, multivariate logistic regression was used to determine those variables predicting conversion of laparoscopic cholecystectomy.

Results: Seventy-one (5.3%) laparoscopic cholecystectomies required conversion. Multivariate analysis revealed that for all cases, a white blood cell count >9 (2.9 greater odds ratio [OR] of conversion P = 0.006) and a gallbladder wall thickness >0.4 cm (7.2 OR, P <0.001) predicted conversion to open cholecystectomy. However, when patients with acute cholecystitis were evaluated only a body mass index >30 kg/m² (5.6 OR, P = 0.02) predicted conversion. For patients undergoing elective cholecystectomy, a body mass index >40 kg/m² (33.1 OR, P = 0.01) and a wall thickness >0.4 cm (24.7 OR, P <0.004) predicted conversion. Finally, an ASA >2 (5.3 OR, P = 0.01) predicted conversion in patients undergoing nonelective cholecystectomies.

Conclusions: Obese patients with acute cholecystitis undergoing laparoscopic cholecystectomy have an increased chance of conversion. Likewise, patients with multiple comorbid diseases undergoing nonelective laparoscopic cholecystectomy are more likely to require conversion. Finally, in an elective laparoscopic cholecystectomy, morbidly obese patients with chronic cholecystitis and a thickened gallbladder wall are more likely to require conversion. These factors can help counsel patients undergoing laparoscopic cholecystectomy with regards to the probability of conversion to an open procedure.

Section snippets

Methods

From January 1996 to January 2000,1,347 laparoscopic cholecystectomies were performed at the CCF. A retrospective analysis of 34 parameters including patient demographics, clinical history, laboratory data, ultrasound results, and intraoperative details was performed. Demographic data included age, American Society of Anesthesiology (ASA) classification, sex, body mass index (BMI), alcohol or tobacco use, concomitant medical conditions (ischemic heart disease, chronic obstructive lung disease,

Results

Of the 1,347 patients in whom laparoscopic cholecystectomy was attempted, 71 (5.3%) required conversion to open surgery. The annual incidence of conversion of laparoscopic to open surgery was analyzed. The conversion rates remained relatively stable throughout the study period and are shown in Fig. 1. The indications for conversion to open cholecystectomy are summarized in Table 1. The most common reason for conversion was severe inflammation and dense adhesions preventing accurate

Comments

The undisputed benefits of laparoscopic cholecystectomy render it the procedure of choice for symptomatic cholelithiasis. With growing experience, laparoscopic cholecystectomy is safe and cost-efficient in an ambulatory setting [15], [16]. However, certain patients still require conversion to an open procedure. Identifying reliable predictive factors for conversion provides benefits for patient education and postoperative expectations. Furthermore, hospital administrators can appropriately plan

References (20)

A. Cuschieri et al.
The European experience with laparoscopic cholecystectomy
Am J Surg
(1991)
G.M. Fried et al.
Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy
Am J Surg
(1994)
N.A. Kama et al.
A risk score for conversion from laparoscopic to open cholecystectomy
Am J Surg
(2001)
A prospective analysis of 1518 laparoscopic cholecystectomies
N Engl J Med
(1991)
T. Buanes et al.
Complications in laparoscopic and open cholecystectomya prospective comparative trial
Surg Laparosc Endosc
(1996)
P. Hollington et al.
A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy
Aust NZ J Surg
(1999)
E. Trondsen et al.
Laparoscopic and open cholecystectomy. A prospective, randomized study
Eur J Surg
(1993)
A. Alponat et al.
Predictive factors for conversion of laparoscopic cholecystectomy
World J Surg
(1997)
M.R. Cox et al.
Laparoscopic cholecystectomy for acute inflammation of the gallbladder
Ann Surg
(1993)
C.L. Liu et al.
Factors affecting conversion of laparoscopic cholecystectomy to open surgery
Arch Surg
(1996)

There are more references available in the full text version of this article.

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During the COVID-19 pandemic, elective surgeries suspension, led to delayed hospital visits for non-emergent diseases like acute cholecystitis. Although nonsurgical treatment was successful in numerous cases, there are some warnings about the progression of the disease to more advanced stages for laparoscopy. In this study, we aimed to find out if COVID-19 had adverse effects on the difficulty of laparoscopic cholecystectomy (LC).
In a retrospective cohort study at a referral center for minimally-invasive surgeries, medical records from February 2019 to February 2020 (before the pandemic) and from February 2020 until 2021 (during the outbreak) were reviewed and various data were extracted. Using two different preoperative scoring systems, we estimated the rate of difficulty of LCs, and the results compared to each other with appropriate statistical methods.
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All patients in the study were operated by the same surgeon. We defined the total duration of the operation as the time from insertion of Veress needle to the extraction of gallbladder (GB) and DLC as a laparoscopic cholecystectomy (LC) that lasted longer than the average duration of LC and the value of one standard deviation.
Multivariate logistic regression analysis identified five predictors significantly related to DLC: GB wall thickness > 4 mm, GB fibrosis, leukocytosis ˃10 × 10⁹ g/L, ˃ 5 pain attacks that lasted longer than 4 h and diabetes mellitus. The sensitivity of the generated index of DLC in our series is 81.8% and specificity 97.2%.
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LaparoscopyPredictive factors for conversion of laparoscopic cholecystectomy

Abstract

Section snippets

Methods

Results

Comments

Am J Surg

Am J Surg

Am J Surg

A prospective analysis of 1518 laparoscopic cholecystectomies

N Engl J Med

Complications in laparoscopic and open cholecystectomya prospective comparative trial

Surg Laparosc Endosc

A prospective randomized trial of day-stay only versus overnight-stay laparoscopic cholecystectomy

Aust NZ J Surg

Laparoscopic and open cholecystectomy. A prospective, randomized study

Eur J Surg

Predictive factors for conversion of laparoscopic cholecystectomy

World J Surg

Laparoscopic cholecystectomy for acute inflammation of the gallbladder

Ann Surg

Factors affecting conversion of laparoscopic cholecystectomy to open surgery

Arch Surg

Laparoscopy
Predictive factors for conversion of laparoscopic cholecystectomy