Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Laparoscopic Cholecystectomy (LC) is the gold standard operation for cholelithiasis; however, conversion to "Open Cholecystectomy (OC)" is still required in some patients.
OBJECTIVE:
Is to assess the predictability of conversion by recognition of probable risk factors, a fact that would be beneficial for patient selection and planning of laparoscopic procedures.
PATIENTS AND METHODS:
Retrospective analysis of data concerning 1350 cases of LC in the last 8 years from 2001 to 2008.
RESULT:
A total of 28 patients required conversion (overall conversion rate of 2.1%). Preoperative clinical, laboratory and radiological data were evaluated with regard to conversion. Six factors; male gender, age above 45 years, presentation as acute cholecystitis(ACs) , history of repeated attacks of ACs, ultrsonographic gall bladder wall thickness of more than 3 mm. and previous history of upper abdominal operation; showed a statistically significant effect on conversion. Three other factors; raised white Blood Cell (WBC) count, Common Bile Duct (CBD) stone(s) and experience of the surgeon; failed to reach significance. On the basis of Univariate analysis results, all significant predictors were allocated a score, which indicate risk score for conversion. Increasing score was associated with a significantly increased probability of conversion. The optimal cutoff score was 2 with a conversion rate of 3.05 %. Conversion rate was 20% with a score of 8.
CONCLUSION:
Risk of conversion is predictable on basis of this scoring. Patients predicted to have high risk of conversion may be informed and scheduled appropriately