How frequent is conversion from laparoscopic to open cholecystectomy and what are predictors of conversion?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Conversion to an open procedure should not be considered a complication, and the possibility that it will prove necessary or advisable should be discussed with the patient preoperatively. In most series, conversion rates are higher with emergency operations. Reported rates range from 1.5% to 15%, with most studies reporting rates around 5% in elective cases. [12]

A multivariate analysis identified male gender, elevated white blood cell count, low serum albumin, pericholecystic fluid noted on ultrasonography, diabetes mellitus, and elevated total bilirubin as independent predictors of conversion. Another multivariate analysis identified male sex, positive Murphy sign, gallbladder wall thickness exceeding 4 mm, and previous upper abdominal surgery as independent predictors of conversion to an open procedure.

The decision to convert to open cholecystectomy should be made when important anatomic structures cannot be clearly identified or when no progress is being made. As a general rule, if the junction of the gallbladder and the cystic duct has not been identified within 30 minutes of the start of the procedure, a laparoscopic cholecystectomy should be converted to an open cholecystectomy.


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