Predictive factors for conversion of laparoscopic cholecystectomy

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

“…bleeding, bowel injury, bile duct injury) or due to failure to progress. 1,2,6 In this analysis, the precise indication for conversion was not collected prospectively, since it was not part of the CholeS dataset. It was assumed that the presence of a bile duct injury, bowel injury or bleeding was the reason for conversion.…”

“…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.…”

“…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.…”

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

“…Evidence for factors that might contribute to surgical difficulty during LC are ambiguous despite several existing studies (preoperative radiological findings [4][5][6], the optimal timing for LC [3,7], indications of preoperative interventions such as percutaneous transhepatic gallbladder drainage [8,9], etc). Most of the previous publications have adopted either the duration of surgery [4][5][6] or open conversion rate [10][11][12][13][14] as surrogate markers for surgical difficulty. However, these factors are strongly affected by the skill of each surgeon and center's policy.…”