Prognostic risk factors for conversion in laparoscopic cholecystectomy

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard technique for the treatment of gallbladder disease. However, in some cases, conversion to open surgery is still necessary. Identification of patients with high risk of conversion is of great importance to prepare the surgical scenario and to anticipate the convalescence. The objective of this study is to identify the factors that may predict a conversion to an open procedure. A total of 1386 LC were performed in Dr. Manuel Gea González General Hospital, from January 2009 to May 2013. A retrospective analysis of 41 parameters in these patients was performed, including demographic variables, clinical history, laboratory studies, ultrasound results and intraoperative findings. Subsequently, a multivariate logistic regression analysis was used to determine the predictive variables for conversion. Fourteen patients required conversion (1%). The multivariate analysis revealed that the factor that was most associated with conversion was emergency surgery (OR 4.9, CI 95% 2.3-2.4), as well as dilatation > 6 mm of the common bile duct in ultrasound (OR 1.8, CI 95% 1.1-1.7), hepatomegaly (OR 1.3, CI 95% 0.3-4.9), diagnosis of chronic cholecystitis associated to previous biliary colics (OR 2.8, CI 95% 1.0-21) and elevated alanine aminotransaminase (OR 1.2, CI 95% 1.0-2.1). Patients with acute symptoms, with dilatation of the bile duct, cholestasis history and hepatomegaly have a higher risk of a conversion surgery. These factors may warn both the patient and the surgeon for a complex surgery and possible complications.

Keywords: Conversion surgery; Endoscopic cholecystectomy; Laparoscopic cholecystectomy.