Surgical Endoscopy

, Volume 14, Issue 8, pp 755–760 | Cite as

Laparoscopic cholecystectomy for acute cholecystitis: Can the need for conversion and the probability of complications be predicted?

A prospective study
  • A. Brodsky
  • I. Matter
  • E. Sabo
  • A. Cohen
  • J. Abrahamson
  • S. Eldar
Original Articles


Background: Laparoscopic cholecystectomy (LC) in acute cholecystitis is associated with a relatively high rate of conversion to an open procedure as well as a high rate of complications. The aim of this study was to analyze prospectively whether the need to convert and the probability of complications is predictable.

Methods: A total of 215 patients undergoing LC for acute cholecystitis were studied prospectively by analyzing the data accumulated in the process of investigation and treatment. Factors associated with conversion and complications were assessed to determine their predictive power.

Results: Conversion was indicated in 44 patients (20.5%), and complications occurred in 36 patients (17%). Male gender and age >60 years were associated with conversion, but these factors had no sensitivity and no positive predictive value. The same factors, together with a disease duration of >96 h, a nonpalpable gallbladder, a white blood count (WBC) of >18,000/cc3, and advanced cholecystitis, predicted conversion with a sensitivity of 74%, a specificity of 86%, a positive predictive value of ∼40%, and a negative predictive value of 96%. However, these data became available only when LC was underway. Male gender and a temperature of >38°C were associated with complications, but these factors had no sensitivity and no positive predictive value. Progression along the stages of admission and therapy did not add predictive factors or improve the predictive characteristics. Male gender, abdominal scar, bilirubin >1 mg%, advanced cholecystitis, and conversion to open cholecystectomy were associated with infectious complications. Their sensitivity and positive predictive value remained 0 despite progression along the stages of admission and therapy.

Conclusion: Although certain preoperative factors are associated with the need to convert a LC for acute cholecystitis, they have limited predictive power. Factors with higher predictive power are obtained only during LC. The need to convert can only be established during an attempt at LC. Preoperative and operative factors associated with total and infectious complications have no predictive power.

Key words

Laparoscopic cholecystectomy Cholecystitis Conversion Complications Gallbladder 


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  1. 1.
    Chahin F, Elias N, Paramesh A, Saba A, Godziachvili V, Silva YJ (1999) The efficacy of laparoscopy in acute cholecystitis. J Soc Laparoendosc Surg 3: 121–125Google Scholar
  2. 2.
    Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RTA, Toouli J (1993) Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg 218: 630–634PubMedCrossRefGoogle Scholar
  3. 3.
    Eldar S, Sabo E, Nash E, Abrahamson J, Matter I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21: 540–545PubMedCrossRefGoogle Scholar
  4. 4.
    Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, Hinchey EJ, Meakins JL (1994) Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 167: 35–39PubMedCrossRefGoogle Scholar
  5. 5.
    Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11: 347–350PubMedCrossRefGoogle Scholar
  6. 6.
    Hashizume M, Sugimachi K, MacFadyen BV (1998) The clinical management and results of surgery for acute cholecystitis. Semin Laparosc Surg 5: 69–80PubMedGoogle Scholar
  7. 7.
    Koo KP, Thirlby RC (1996) Laparoscopic cholecystectomy in acute cholecystitis: what is the optimal timing for operation? Arch Surg 131: 540–544PubMedGoogle Scholar
  8. 8.
    Koperna T, Kisser M, Schulz F (1999) Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 46: 753–757PubMedGoogle Scholar
  9. 9.
    Kum CK, Goh PMY, Isaac JR, Tekant Y, Ngoi SS (1994) Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81: 1651–1654PubMedCrossRefGoogle Scholar
  10. 10.
    Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85: 764–767PubMedCrossRefGoogle Scholar
  11. 11.
    Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227: 461–467PubMedCrossRefGoogle Scholar
  12. 12.
    Lo CM, Liu CL, Lai EC, Fan ST, Wong J (1996) Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg 223: 37–42PubMedCrossRefGoogle Scholar
  13. 13.
    Lujan JA, Parrilla P, Robles R, Torralba JA, Garcia Ayllon J, Liron R, Sanchez-Bueno F (1995) Laparoscopic cholecystectomy in the treatment of acute cholecystitis. J Am Coll Surg 181: 75–77PubMedGoogle Scholar
  14. 14.
    Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64: 955–957PubMedGoogle Scholar
  15. 15.
    Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217: 233–236PubMedCrossRefGoogle Scholar
  16. 16.
    Sanabria JR, Gallinger S, Croxford R, Strasberg SM (1994) Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg 179: 696–704PubMedGoogle Scholar
  17. 17.
    Singer JA, McKeen RV (1994) Laparoscopic cholecystectomy for acute or gangrenous cholecystitis. Am Surg 60: 326–328PubMedGoogle Scholar
  18. 18.
    Willsher PC, Sanabria JR, Gallinger S, Rossi L, Strasberg S, Litwin DE (1999) Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure. J Gastrointest Surg 3: 50–53PubMedCrossRefGoogle Scholar
  19. 19.
    Zucker KA, Bailey RW, Flowers J (1992) Laparoscopic management of acute and chronic cholecystitis. Surg Clin North Am 72: 1045–1067PubMedGoogle Scholar
  20. 20.
    Zucker KA, Flowers JL, Baily RW, Graham SM, Buell J, Imbembo AL (1993) Laparoscopic management of acute cholecystitis. Am J Surg 165: 508–514PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • A. Brodsky
    • 1
  • I. Matter
    • 1
  • E. Sabo
    • 1
  • A. Cohen
    • 1
  • J. Abrahamson
    • 1
  • S. Eldar
    • 1
  1. 1.Department of Surgery, Bnai Zion Medical Center, the Faculty of Medicine, and the Faculty of Industrial Engineering and Management, the TechnionIsrael institute of TechnologyHaifaIsrael

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