Bratisl Lek Listy 2009; 110 (11) $&& ` $' Indexed and abstracted in Science Citation Index Expanded and in Journal Citation Reports/Science Edition CLINICAL STUDY Predictive factors for conversion of laparoscopic cholecystectomy in patients with acute cholecystitis Gurkan Yetkin, Mehmet Uludag, Bulent Citgez, Ismail Akgun, Sinan Karakoc Department of Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey Address for correspondence: Gurkan Yetkin, Ataköy 3. kisim O/8 blok. Daire: 7 Bakirköy, Istanbul 34158, Turkey. GSM: 0.532.6139471 Department of Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey. dryetkin@yahoo.com Abstract: Objectives: Laparoscopic management of acute cholecystitis may still be associated with increased risk of complications and the conversion rate to open cholecystectomy is accordingly higher when compared to elective cases. The aim of this study was to evaluate preoperative factors associated with conversion in acute cholecystitis. Patients: The records of 108 patients who underwent early laparoscopic cholecystectomy for acute cholecystitis. Results: Of 108 patients, 19 (17.59 %) needed conversion to open cholecystectomy. Fifteen patients who required conversion to open cholecystectomy had severe inflammation and adhesions obscuring the plane of dissection and anatomy around Calot’s triangle. For the remaining four patients, conversion was also neces- sary because of uncontrolled bleeding. Linear regression analysis revealed that advanced age (p=0.029), obesity (p=0.024) and pericholecystic fluid at the USG (p=0.009) were statistically significant risk factors for conversion. Conclusion: The identified risk factors do not contraindicate laparoscopic cholecystectomy; however surgeons should avoid laparoscopy-associated complications by performing open operations when appropriate (Tab. 3, Ref. 26). Full Text (Free, PDF) www.bmj.sk. Key words: acute cholecystitis, laparoscopic cholecystectomy, conversion, complication, length of stay. Since its introduction, laparoscopic cholecystectomy (LC) has become the procedure of choice for the treatment of symp- tomatic gallstones and chronic cholecystitis. During the initial development of LC, acute cholecystitis was considered to be a relative contraindication because the rates of perioperative com- plications were observed to be higher when compared to open cholecystectomy (1, 2). Improvements in operative skills and ad- vances in instrumentation have allowed surgeons to attempt to treat inflamed gallbladders laparoscopically. This procedure has been reported to be safe (3, 4) but there are still limitations in- herent in the two-dimensional view and lack of tactile sensation during laparoscopic surgery. These disadvantages are amplified in the presence of acute inflammation. Thus the conversion rate to open cholecystectomy is higher when compared to elective cases (5). The aim of this study was to define predictive factors of conversion in patients who had undergone early LC for acute cholecystitis. Patients and method The analysis was based on data of 108 patients who were admitted to the hospital between January 2002 and December 2007 on an emergency basis for acute cholecystitis and under- went laparoscopic cholecystectomy within 72 hours of the onset of their symptoms. The diagnosis of acute cholecystitis was based on right upper abdominal pain, positive Murphy sign, fever and/ or leucocytosis, as well as USG findings matching acute chole- cystitis such as thickened gallbladder wall, gallstones and pericholecystic fluid collection. In all patients, the definite diag- nosis of acute cholecystitis was made during the operation and confirmed by histopathological examination. All patients with acute cholecystitis except four had normal liver function, and no dilation or stones in the bile duct were observed. Of the four patients who were excluded from the study, two had common bile duct stones, one was pregnant and the other had possibly gallbladder cancer. Operative Technique The Standard four-trocar technique is used for all laparoscopic cholecystectomies. First, a 10 mm Hassons trocar is inserted via open method in the subumbilical region. Three ports (10-mm epigastric and 2x5-mm on the right side along the subcostal margin) are inserted under direct vision. Needle decompression of the gallbladder is performed whenever necessary. Dissection commences at Calots triangle using monopolar electrocautery. Operative cholangiograms are not routinely performed. After it is freed from the liver, the gallbladder is extracted through the subumblical port site using an extraction bag. The decision for the conversion to laparotomy is based on the clinical judgement of the surgeon.