Rate and Reasons of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy? a Prospective Analysis of 450 Consecutive Laparoscopic Cholecystectomies

Objective: To assess the rate and causes of conversion of laparoscopic to open cholecystectomy (OC) in 450 patients who underwent laparoscopic cholecystectomy (LC) by the same surgeon in tertiary care teaching hospitals. Study Design: Descriptive study. Place and Duration of Study: The study was conducted initially at Pakistan Navalship (PNS) Shifa, Karachi and later at Combined Military Hospital, Lahore from November 2009 to June 2013. Material and Methods: All the patients of both genders and of any age group, undergoing LC for gall bladder pathology whether acute or chronic, acalculous or calculous were included in this study by convenient sampling. The exclusion criteria were choledocholithiasis, malignancy, and patients who willingly opted for open cholecystectomy. All the patients were operated by the same experienced laparoscopic surgeon. The number and sizes of the ports varied from patient to patient and was on the choice of the operating surgeon. A detailed proforma was filled which included the demographic data of the patients, indications for cholecystectomy, histories of previous abdominal surgery, their comorbidities (if any), operating time, intraoperative findings, complications, post-operative hospital stay and rate and reasons for conversion to open cholecystectomy (if required). Results: Out of 450 consecutive patients for whom LC was attempted by a single surgeon, 7 patients (1.6%) were converted to OC. There were 380 female and 70 male patients (F: M ratio 5.4:1). Their mean age was 44.6 ± 13.5 years, ranging from 9-82 years. All patients who required conversion to OC were females. The mean operating time was 38.9 ± 16.2 minutes (range 15-120 minutes). The reasons for conversion included cystic artery bleeding2, liver bed bleeding1, common hepatic duct injury1, cholecystoduodenal fistula1, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle1 and cystic duct avulsion1. Conclusion: The overall rate of conversion to OC was 1.6%. Laparoscopic cholecystectomy is a safe procedure with very little chances of conversion to open even in acute cases, when performed by an experienced surgeon.