Summary
BACKGROUND: The first laparoscopic cholecystectomy (LC) in Austria was performed on March 22nd, 1990 at the General Hospital Linz. As the experience increased during time the scope of contraindications has been narrowed and the rate of conversion has been decreased. However, acute cholecystitis still leads to a higher conversion rate. METHODS: We retrospectively analysed all cholecystectomies from 1990 till 2010. All acute cholecystectomies have been carried out with regard to conversion, risk factors for conversion, morbidity and mortality. RESULTS: We performed 7541 cholecystectomies. 701 (9.3%) patients had primary open cholecystectomy (OC) and 452 (6%) had concomitant CHE without further evaluation for this study. From the remaining 6139 patients with LC 1775 (male 885 [36%], female 890 [21%]) have been operated due to acute cholecystitis. 141 (7.9%, 78 male, 63 female, median age 66 years, range 20–94) of them led to conversion. The acute inflammation itself including difficulties in Calot's triangle was the most common cause for conversion (56%) followed by adhesions (19.1%). Two patients have been converted due to common bile duct lesion (1.4%) In case of acute operation and conversion the mortality was 5%, morbidity was 20%. Out of the 4364 patients with elective LC 200 had to be converted (4.6%). The overall conversion rate was 5.5%. The Reoperation rate after conversion was 6.3% (n = 9). CONCLUSIONS: Acute cholecystitis leads significantly more often to conversion as in elective LC. Male patients present at the clinic more frequent than female with acute cholecystitis, but in the acute situation the conversion rate is equal.
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Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis. Arch Surg 1998;133:173–5
Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic versus open cholecystectomy in acute cholecystitis. Surg Laparosc Endosc 1997;7:407–14
Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998:351(9099):321–5
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004;188:205–11
Peters JH, Krailadsiri W, Incarbone R, et al. Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital. Am J Surg 1994;168:555–8
Wölnerhanssen BK, Ackermann C, Guenin MO, et al. Twelve years of laparoscopic cholecystectomy. Chirurg 2005;76:263–9
Moll Harboe K, Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 2011;25:1630–41
Ballal M, David G, Willmott S, Corless DJ, Deakin M, Slavin JP. Conversion after laparoscopic cholecystectomy in England. Surg Endosc 2009;23:2206–9
Shamiyeh A, Danis J, Wayand W, Zehetner J. A 14-year Analysis of Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2007;17:271–6
Borzellino G, Sauerland S, Minicozzi AM, et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results. Surg Endosc 2008;22:8–15
Schiedeck THK, Schulte T, Gunarsson R, Bruch HP. Laparoscopic Cholecystectomy in acute cholecystitis. Minim Invasiv Chirurg 1997;6:48–51
Low SW, Iyer SG, Chang SK, Mak KS, Lee VT, Madhavan K. Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates. Surg Endosc 2009;23:2424–9
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101–25
Tang B, Hanna GB, Joice P, Cuschieri A. Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 2004;139:1215–20
Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997;173:513–7
Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 1997;21:629–33
Karayiannakis AJ, Polychronidis A, Perente S, Botaitis S, Simopoulos C. Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Surg Endosc 2004;18:97–101
Wongworawat MD, Aitken DR, Robles AE, Garberoglio C. The impact of prior intra-abdominal surgery on laparoscopic cholecystectomy. Am Surg 1994;60:763–6
Orlando R, Palatini P, Lirussi F. Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications? J Laparoendosc Adv Surg Tech A 2003;13:181–4
Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002;325(7365):639–43
Lipmann JM, Caridge JA, Haridas M, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007;142:556–65
Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007;14:91–7
Vamvakas P, Nikolaidou G, Sikalias N, Kotsifas T. Acute cholecystitis: when is the best time for laparoscopic cholecystectomy? BMMR 2006;9:17–9
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*: A tribute to Wolfgang Wayand, Head of Department, 1 January 1985–31 March 2012, Department of Surgery II, General Hospital Linz, Linz, Austria
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Szabo, K., Rothe, A. & Shamiyeh, A. Laparoscopic cholecystectomy – review over 20 years with attention on acute cholecystitis and conversion* . Eur Surg 44, 28–32 (2012). https://doi.org/10.1007/s10353-012-0072-0
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DOI: https://doi.org/10.1007/s10353-012-0072-0