IDENTIFICATION OF RISK FACTORS FOR CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Abstract

Background: Laparoscopic cholecystectomy (LC) is the preferred approach for the treatment of gallbladder stones, but occasionally conversion to open cholecystectomy (OC) may be necessary for safety reasons. Knowing the preoperative and intraoperative risk factors helps in surgical decision making and counselling.

Methods:
This was a prospective observational study involving 200 patients undergoing LC at Jinnah Postgraduate Medical Centre, Karachi. Data regarding age, gender, body mass index, comorbidities, laboratory and radiological findings was collected. Operative details and causes of conversion were noted. Chi-square and independent t-tests (p<0.05) were used for statistical comparisons. Logistic regression analysis was performed to determine predictors of conversion

Results:
Out of 200 patients, 30 (15%) required conversion to OC. Advanced age (≥60 years) was significantly associated with conversion (p<0.05), with 45% of elderly patients requiring conversion. Male patients had a higher conversion rate (33.3%) compared to females (7.1%) (p<0.05). Obesity (BMI >30 kg/m²) increased conversion risk (36% vs. 8%, p<0.05). Acute cholecystitis patients had a significantly higher conversion rate (33.3%) than elective LC cases (7.1%, p<0.05). Preoperative imaging findings, including gallbladder wall thickening (31.4% conversion rate), pericholecystic fluid (32%), and CBD dilation (40%), were strong predictors of conversion. Intraoperative challenges such as dense adhesions in Calot’s triangle (60% of converted cases), excessive bleeding (26.7%), and difficult anatomical dissection (23.3%) were major contributors to conversion. Patients requiring conversion had a longer hospital stay (5.2 ± 1.2 days vs. 2.1 ± 0.5 days, p<0.05) and a higher rate of minor wound infections (13.3% vs. 2.9%), but no major complications were observed.

Conclusion:
everal factors, including patient characteristics and intra-operative events, contribute to the conversion from LC to OC. By identifying risk factors before surgery, surgeons can better plan the procedure and avoid complications and poor outcomes. Conversion should be encouraged to achieve good surgical outcomes.