Abstract
Background
Risk factors for conversion in cholecystectomy may be of clinical value. This study aimed to investigate whether a set of risk factors, including the surgeon’s specialization, can be used for the development of a preoperative strategy to optimize conversion outcome.
Methods
The data for all patients who underwent laparoscopic cholecystectomy at a single institution between January 2004 and December 2008 were retrospectively reviewed. Factors predictive for conversion were identified, and a preoperative strategy model was deduced.
Results
Of the 1,126 patients analyzed, 106 (9%) underwent laparoscopic cholecystectomy in an emergency setting. Delayed surgery was performed for 63 (46%) of 138 patients (12%) with acute cholecystitis. Preoperative endoscopic retrograde cholangiography was achieved for 161 of the patients (14%). Risk factors predictive of conversion (for 65 patients) were male gender [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.3–3.9; p = 0.004], age older than 65 years (OR, 2.6; 95% CI, 1.4–4.8; p = 0.002), body mass index (BMI) exceeding 25 kg/m2 (OR, 3.4; 95% CI, 1.7–7.1; p < 0.001), history of complicated biliary disease (HCBD) (OR, 5.6; 95% CI, 3.2–9.8; p = < 0.001), and surgery by a non-gastrointestinal (non-GI) surgeon (OR, 4.9; 95% CI, 2.2–10.6; p < 0.001). The conversion rate for patients with a history of no complications who had two or more risk factors (gender, age, BMI > 25) and for patients with a HCBD who had one or more risk factors was significantly higher if the surgery was performed by non-GI rather than GI surgeons.
Conclusion
Male gender, age older than 65 years, BMI exceeding 25 kg/m2, HCBD, and surgery by a non-GI surgeon are predictive for conversion. A preoperative triage for surgeon selection based on risk factors and a HCBD is proposed to optimize conversion outcome.
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Disclosure
Sandra C. Donkervoort, Lea M. Dijksman, Lincey C.F. de Nes, Pieter G. Versluis, Joris Derksen, and Michael F. Gerhards have no conflicts of interest or financial ties to disclose.
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Donkervoort, S.C., Dijksman, L.M., de Nes, L.C.F. et al. Outcome of laparoscopic cholecystectomy conversion: is the surgeon’s selection needed?. Surg Endosc 26, 2360–2366 (2012). https://doi.org/10.1007/s00464-012-2189-4
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DOI: https://doi.org/10.1007/s00464-012-2189-4