Laparoscopic Cholecystectomy Open Conversion Causes and Incidence

Abstract

Abstract: Background: Laparoscopic cholecystectomy (LC) has become the standard method of treatment for patients with chronic cholecystitis.Objective: predict the risk of conversion preoperatively for selected patients arrange operating schedules, team and equipments. Minimize the procedure – related cost and help overcome financial constraint. Also prepare patients psychologically.Patients and Method: Two hundred and fourteen patients presented with calculus cholecystitis underwent laparoscopic cholecystectomy at Gastroenterology and Hepatology Teaching Hospital and Dijla Private Hospital from November 2002 to June 2008. Patients' age, sex and clinical history were evaluated. All patients subjected to abdominal ultrasonic examination. Laboratory investigations with liver function test were also taken. All patients whom presented with acute cholecystitis and suspicious malignancies were excluded from this study.Results: Out of (214) patients, 30 patients (14%) require conversion to OC. Significant predictors of conversion were: male gender, history of jaundice, presence of palpable gallbladder, and ultrasonic findings of contracted gallbladder. The main causes of conversion were obscured anatomy (56%), bleeding during dissection which difficulty to control by laparoscope (10%), and empyma of gallbladder 10%. Conclusions: Initiation of international criteria for patients with high risk of conversion and for selection of patients for OC. Further evaluations of new risk factors are responsible for conversion.Key words: Laparoscopic cholecystectomy, open cholecystectomy.