The Risk Factors Associated with the Conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy in Bhuddhasothorn Hospital

Abstract

This study aimed to investigate the risk factors and causes related to the conversion from the laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) in Bhuddhasothorn Hospital. A retrospective cohort study was conducted. Medical records of patients undergone LC in Bhuddhasothorn Hospital from 2015 to 2019 were reviewed. Patient profiles, history of gallstone complications, pre-operative diagnosis, ultrasound images, computed tomographic findings, and laboratory results were evaluated. Odds ratio (OR) and multivariate logistic regression were employed for statistical analyses.

A total of 278 patients undergone LC were reviewed. Among those patients, 248 patients were successfully completed with LC while 30 patients had a conversion from LC to OC. The conversion rate was 10.8%. Multivariate logistic regression indicated 4 strong risk factors; diagnosis of acute cholecystitis (OR=13.2), diagnosis of post-acute gallstone pancreatitis (OR=9.5), history of acute cholecystitis before 3 weeks (OR=6.8), and history of jaundice or cholangitis before 3 weeks (OR=6.6). The major intraoperative cause of the conversion was unclear anatomy or adhesion (73.3%). This study in Bhuddhasothorn Hospital demonstrated that LC is a safe operation. The risk factors in association with the conversion from LC to OC are related to the complications of gallstones and the major cause of the conversion was unclear anatomy or adhesion.

Keywords: Laparoscopic cholecystectomy; Open cholecystectomy; Conversion; Risk factors