Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 12 , ISSUE 1 ( January-June, 2022 ) > List of Articles

Original Article

The Association of Preoperative Risk Factors for Laparoscopic Conversion to Open Surgery in Elective Cholecystectomy

Erik Hanson-Viana, Edwin A Ayala-Moreno, Luis H Ortega-Leon, Eduardo E Montalvo-Javé

Keywords : Cholecystectomy, Conversion, Conversion to open surgery, General, Laparoscopic, Laparoscopy, Risk factors cholecystectomy, Surgery

Citation Information : Hanson-Viana E, Ayala-Moreno EA, Ortega-Leon LH, Montalvo-Javé EE. The Association of Preoperative Risk Factors for Laparoscopic Conversion to Open Surgery in Elective Cholecystectomy. Euroasian J Hepatogastroenterol 2022; 12 (1):6-9.

DOI: 10.5005/jp-journals-10018-1366

License: CC BY-NC 4.0

Published Online: 13-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Laparoscopic cholecystectomy is a common operation worldwide, with low mortality (0.01%) and morbidity (2–8%). It has been reported 2.9 to 3.2% of elective laparoscopic cholecystectomies are converted to open surgery. Converted cases are associated with increased complications rates. Method: Two thousand and seventy-five patients, 82.8% females and 17.2% males who underwent elective laparoscopic cholecystectomy in our hospital, between March 1, 2016, and February 28, 2018, were prospectively collected in a database. Pearson's Chi-squared and Fisher's exact tests were used to determine significance, with p <0.05 deemed statistically significant. We analyzed seven risk factors associated with conversion to open surgery; age, gender, body mass index (BMI), previous abdominal surgeries, the presence of contracted gallbladder, Mirizzi syndrome, or choledocholithiasis. Laparoscopic cholecystectomy was performed using a 3-port technique (73%) and a 4-port technique (27%). Results: Finding associated “strong” factors to conversion: male patients, >60-years-old, previous upper abdominal surgery, contracted gallbladder, Mirizzi syndrome or choledocholithiasis. The presence of a higher or lower BMI did not influence the rate of conversion. The most impact association were males over 60 years, and males with an earlier upper abdominal surgery. Conclusion: Laparoscopic cholecystectomy is the gold standard for gallstones and gallbladder disease; however, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. This study identifies predictors of choice for open cholecystectomy. In view of the raised morbidity and mortality associated with open cholecystectomy, distinguishing these predictors will serve to decrease the rate of conversion and address these factors preoperatively.

PDF Share
  1. Reynolds W. The first laparoscopic cholecystectomy. JSLS 2001;5(1):89–94. PMID: 11304004.
  2. Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 1998;2(4):341–346. PMID: 10036125.
  3. Dubois F, Icard P, Berthelot G, et al. Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 1990;211(1):60–62. DOI: 10.1097/00000658-199001000-00010.
  4. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc 1989;3(3):131–133. DOI: 10.1007/BF00591357.
  5. Cuschieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161(3):385–387. DOI: 10.1016/0002-9610(91)90603-b.
  6. Reynolds W. The first laparoscopic cholecystectomy. J Soc Laparoendosc Surg 2001;5(1):89–94. PMID: 11304004.
  7. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004;188(3): 205–211. DOI: 10.1016/j.amjsurg.2004.06.013.
  8. Philip Rothman J, Burcharth J, Pommergaard HC, et al. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery—a systematic review and meta-analysis of observational studies. Dig Surg 2016;33(5):414–423. DOI: 10.1159/000445505.
  9. Shiun A, Hu Y, Menon R, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery: a systematic literature review of 30 studies. Am J Surg 2017;214(5):920–930. DOI: 10.1016/j.amjsurg.2017.07.029.
  10. Tang B, Cuschieri A. Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg 2006;10(7):1081–1091. DOI: 10.1016/j.gassur.2005.12.001.
  11. Hasson HMMD. A modified instrument for laparoscopy. Am J Obstet Gynecol 1971;110(6):886–887. DOI: 10.1016/0002-9378(71) 90593-x.
  12. Simopoulos C, Botaitis S, Polychronidis A, et al. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc 2005;19(7):905–909. DOI: 10.1007/s00464-004-2197-0.
  13. Kais H, Hershkovitz Y, Abusnina Y, et al. Different setups of laparoscopic cholecystectomy: conversion and complication rates: a retrospective cohort study. Int J Surg 2018;12(12):1258–1261. DOI: 10.1016/j.ijsu.2014.10.006.
  14. Ortega-León LH, Vargas-Domínguez A, Ramírez-Tapia D, et al. Causas de conversion a cirugia abierta en la colecistectomia laparoscopica. Rev Mex Cir del Apar Dig 2015;4(2):55–61.
  15. Kaafarani HMA, Smith TS, Neumayer L, et al. Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 2018;200(1): 32–40. DOI: 10.1016/j.amjsurg.2009.08.020.
  16. Yetkin G, Uludag M, Oba S, et al. Laparoscopic cholecystectomy in elderly patients. J Soc Laparoendosc Surg 2009;13(4):587–591. DOI: 10.4293/108680809X1258998404604.
  17. Beltrán MA. Mirizzi syndrome: history, current knowledge and proposal of a simplified classification. World J Gastroenterol 2012;18(34):4639–4650. DOI: 10.3748/wjg.v18.i34.4639.
  18. Reverdito R, Moricz A, Campos T de, et al. Mirizzi syndrome grades III and IV: surgical treatment. Rev Col Bras Cir 2016;43(4):243–247. DOI: 10.1590/0100-69912016004005.
  19. Liu C, Fan S, Lai ECS, et al. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 1996;131(1):98–101. DOI: 10.1001/archsurg.1996.01430130100022.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.