Reasons of conversion of laparoscopic to open cholecystectomy in a tertiary care institution

Objective: To determine the frequency and reasons of conversion of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) in a tertiary care teaching hospital. Methods: A prospective analysis of conversion of laparoscopic to OC was performed in one Surgical Unit of Civil Hospital Karachi, from 1st September 1997 to 31st May 2005. There were 1238 patients in the series. The inclusion criteria were: all patients with symptomatic cholelithiasis, who were subjected to LC. The exclusion criteria were: cases with incomplete laboratory or histopathology data, patients who were lost to follow-up, and patients with preoperative diagnosis of carcinoma of gallbladder. Results: Eighty-one (6.5%) patients were converted to OC, due to difficult anatomy, complication or equipment failure. The frequency during learning curve was 9% vs. 6.3% during skill curve. The conversion rate was higher in male patients (16.45% males vs. 5.09% females), and in patients with acute cholecystitis (24.39% acute vs. 5.06% chronic). In eight cases, conversion was due to major complication: bleeding (6), and bowel injury (2). In 73 cases, conversion was carried out electively; disturbed anatomy at Calot's triangle (44), wide cystic duct (7), choledocholithiasis (5), dense adhesions between gallbladder and bowel (4), biliodigestive fistula (1), and equipment failure (12). Conclusion: The overall frequency of conversion of LC to OC was 6.5%; the risk was more during the learning curve, in male patients and in patients with acute cholecystitis.