Introduction: Laparoscopic cholecystectomy is the treatment of choice for various gall bladder diseases. However in 5-10%, certain cases still require conversion to conventional cholecystectomy. The aim of this study is to identify the factors and likelihood of conversion rates in experienced surgeons when performing laparoscopic cholecystectomy.
Methods A retrospective and prospective analysis of 3090 patients who were attempted for laparoscopic cholecystecomy by three experienced surgeons in two different surgical units of Chung ang University medical center and Chung ang University Yong san Hospital, from 1st January, 2005 to 1st January, 2009 were performed. Multiple parameters that influence conversions including patient factors (sex, age, ASA scores, previous operation history, BMI), clinical factors (Symptoms, initial body temperature, preoperative ultrasonographic GB wall thickness, combined CBD stones) and surgical factor (operator, pericholecystic fluid collection, reasons for conversions) were reviewed by univariate analysis. The statically significant factors were selected and multivariate analysis was performed. As for the operator factor patients were divided into three subgroups (group A, B, C) as per operators and comparison was investigated between the surgeons.
Results Overall conversion rates were 7.7%. Patient factors contributing to conversions were male sex, high BMI, preoperative GB wall thickness, pericholecystic fluid collection, Murphy’s sign. On multivariate analysis initial body temperature(odds ratio 1.033, p<0.001), GB wall thickening (odds ratio 1.081, p=0.003), male sex (odds ratio 1.62, p=0.001), Murphy sign(odds ratio 3.321, p<0.001), operator(odds ratio 1.394, p<0.001). Conversion rates among the three subgroups differed by A 6.4% B 19.9% C 4.6%. Reason for conversion (adhesion, bleeding, bile duct injury, disturbed anatomy, cancer) showed A (47%, 27%, 10%, 10%, 0%) Vs group B (54%, 13%, 24%, 15%, 0%) Vs group C (35%, 21%, 12.5%, 20%, 1%). Conversion rate among the groups by disease severity, GB polyp, asymptomatic stone, acalculus cholecystitis, acute cholecystitis, chronic cholecystitis, empyema and were A (0%, 3%, 4%, 11%, 7%, 34%), B (12.5%, 15.5%, 18%, 25%, 4%, 45%), C (0%, 23%, 2%,0%, 2%, 18%).
Conclusions The patient risk factor and clinical severity of disease is the well known conversion factor for laparoscopic cholecystectomy. In this study the reason for conversion was relatively constant for bleeding and bile duct injury among the groups but varies when encountering adhesion and complex biliary anatomy. Therefore it is not only the patient factor and disease severity but the operator itself is a factor for conversion.
Program Number: P413