Conversion after laparoscopic cholecystectomy in England

Abstract

Conversion after laparoscopic cholecystectomy is less common as consultant caseload increases. This suggests that operation should be undertaken only by surgeons with an adequate caseload. There is a wide variation in conversion rates among hospitals. This has important implications for training as well as for the organization and accreditation of cholecystectomy services on a national basis.

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

“…This is in part due to selection bias, and these findings are compatible with previously published reports. [1][2][3][4] The threshold for conversion is likely to vary between surgeons, and may relate to several factors, such as experience, procedural difficulty (e.g. bile duct exploration) and possibly logistic issues (e.g.…”

“…Conversion to an open procedure is necessary in 5-10% of patients, and is associated with increased morbidity, prolonged hospitalization and longer recovery compared to a laparoscopic approach. [1][2][3][4] Common indications for conversion include failure to demonstrate the 'critical view of safety' , 1,2,5,6 or the presence of an intraoperative complication, such as intestinal perforation, haemorrhage or bile duct injury. Several factors increase the risk of conversion to open, including age, 4 male sex, 3,7 obesity, 1,2 cholecystitis 2,3,7 and previous ERCP.…”

“…[1][2][3][4] Common indications for conversion include failure to demonstrate the 'critical view of safety' , 1,2,5,6 or the presence of an intraoperative complication, such as intestinal perforation, haemorrhage or bile duct injury. Several factors increase the risk of conversion to open, including age, 4 male sex, 3,7 obesity, 1,2 cholecystitis 2,3,7 and previous ERCP. 8 Conversion to open surgery usually indicates a difficult procedure, and rather than being considered a complication, the decision to convert should be regarded as a sign of good judgement in the presence of adverse conditions.…”

“…Low risk patients could be identified and appropriately scheduled in an ambulatory care facility, and selected as training cases for surgical trainees, 9 whilst high risk patients should be appropriately counselled and operated by experienced surgeons. The majority of studies that have evaluated risk factors for conversion to open cholecystectomy are small retrospective series or population-based databases [1][2][3][4]6,7,[10][11][12][13][14] (Table 1). Several studies have developed risk scores, but their clinical utility is limited by retrospective data, small sample sizes and/or lack of validation.…”

Reply to: Conversion after laparoscopic cholecystectomy in England

“…We thank Dr. Hussain et al [1] for their positive comments on our article [2]. We, of course, agree that all the factors mentioned in their letter are predictors of conversion.…”