Laparoscopic cholecystectomy. Cause of conversions in 1,300 patients and analysis of risk factors.

In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 patients (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic regression analysis of 23 parameters identified the following data as associated with a higher risk for conversion: pain or rigidity in the right upper abdomen (P < 0.01), thickening of the gallbladder wall on preoperative ultrasound (P < 0.05), intraoperatively found dense adhesions to the gallbladder or in Calot's triangle (P < 0.001), and intraoperatively found acute inflammation of the gallbladder (P < 0.01). Clinical findings of an acute cholecystitis associated with intraoperative dense scarring in Calot's triangle were the best factors predicting conversion from LC to OC. As a result of the study we preoperatively select our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complications low.