Preoperative Risk Factors Affecting Conversion of Laparoscopic to Open Cholecystectomy Adil Rahman Faraj Al-Budaerany* FICMS, Muatez Mundhir Manhal* FIBMS, Jaber Qataa Jaber Al-Mohammedawi* FICMS
Background: Conversion from laparoscopic cholecystectomy to an open procedure is necessary in 5-10% of patients, and is associated with increased morbidity, prolonged hospitalization and longer recovery compared to a laparoscopic approach.
Objectives: To evaluate the preoperative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.
Methods: A cross-sectional case series study included 100 patients who underwent laparoscopic cholecystectomy conducted in the surgical unit, department of surgery, Al-Khidhir Hospital in Al-Muthanna province during a period of 18 months from July 2016 to January 2018. Patients diagnosed with malignancy and patients with incomplete information with respect to anthropometry, laboratory investigations, and ultrasound findings were excluded from the study. Preoperative variables were compared between those patients who underwent laparoscopic surgery, and those that required conversion to open surgery. The operative findings and intraoperative complication was recorded.
Results: The most common cause of conversion from laparoscopic cholecystectomy to open cholecystectomy was dense adhesion with unclear Calot’s triangle (66.7%). The rate of conversion to open cholecystectomy was significantly higher among patients aged ≥ 50 years (17.1%, P=0.048), male patients (30.4%, P=0.002), patients with history of previous scar (66.7%, P=0.001), with a history of ERCP (37.5%, P=0.003), with gall bladder thickness of ≥ 4mm (44.4%, P=0.001), with dilated CBD (50%, P=0.001) and with previous attacks of acute cholecystitis (26.3%, P=0.003).
Conclusion: Major risks for conversions in this study is due to disturbed anatomy either from dense adhesions or anatomical variations, and in male gender, aging, previous abdominal scar, recurrent attacks of acute cholecystitis, history of ERCP and dilated CBD.
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