Causes and frequency of conversion during laparoscopic cholecystectomy in own material

Aim: To assess the causes, frequency and time of conversion from laparoscopic to classic cholecystectomy in our own material.

Material and methods: 547 patients were qualified for laparoscopic cholecystectomy in the Surgery Department of the Mogilno District Hospital in Strzelno during the period of 1999-2005; 515 minimally invasive operations were performed and 32 patients required conversion.

Results: The 547 patients were qualified for the laparoscopic operation; of these 148 were operated on as emergency cases and 399 as elective cases. There were 20 conversions among emergency patients and 12 conversions among elective patients. On average the decision to convert was made in the 35th min of the operation. The shortest time to conversion was 15 min and the longest was 90 min. Five conversions were performed in the 25th and 35th min and 4 in the 20th, 30th, and 40th mine. Most frequently conversions occurred between the 20th and 40th min of the procedure. Intentional conversions were performed in 27 patients. Adhesions and clumps around the gallbladder were the cause of conversion in 10 patients and that was the most frequent reason for the operative modality change. The next cause of conversion was changes observed in the course of acute cholecystitis in the form of gallbladder empyema or cholecystocele (9 patients). Small, fibrotic gallbladder, immersed in the liver, was the reason for conversion in a further 4 patients. In 4 cases the conversion was caused by difficulties in the identification of anatomical structures. Four cases of forced conversions and 1 anticipated conversion were found in the analysed material.

Conclusions: A change of operative modality during laparoscopic cholecystectomy was made on average in 5.85% of operations. The average time before the conversion was 35 min. Emergency patients required a change of operative modality 4 times more often. The most frequent were intentional conversions (84%), caused by pericystic adhesions and by inflammatory changes impeding the identification of anatomical structures. The predominant cause of forced conversions was intra-operative haemorrhage.