Laparoscopic to Open Cholecystectomy: The Risk Factors and the Reasons; A Retrospective Analysis of 1950 Cases of a Single Tertiary Center.

PURPOSE: We investigated the reasons, rates, and risk factors for the conversion to open cholecystectomies (CTOC) by statistical analysis with the demographic properties.

MATERIALS AND METHODS: Demographic properties (age and sex), abdominal operations, and intraoperative and postoperative reasons for cholecystectomies were analyzed in 1950 patients.

RESULTS: The patients included 1540 (79%) women and 410 (21%) men (F/M=3.8); of these 115 (5.9%) had CTOC in early or late period. The rate of CTOC in men was significantly high (P= 0.009). There was no mortality. The reasons for CTOC were: significant inflammation (n=53, 46%), inadequate dissection of Calot triangle due to fibrotic adhesions (n=31, 27%), adhesions of previous surgery (n=9, 7.8%), uncontrollable bleeding (n=5, 4.3%), technical insufficiency (n=5, 4.3%), bile duct injury (n=5, 4.3%), anatomical variations (n=3, 2.6%), iatrogenic visceral injury (n=2, 1.7%), isolated right posterior bile duct injury (strasberg type-C) (n=1, 0.9%), and common hepatic duct partial injury (n=1, 0.9%).

CONCLUSIONS: Significant inflammation, inadequate dissection of Calot triangle due to fibrotic adhesions, and adhesions due to previous surgery were the 3 main reasons for conversion. Men and elderly patients were associated with significantly high rate of conversion.