Updates in Surgery

, Volume 70, Issue 1, pp 67–72 | Cite as

Prognostic risk factors for conversion in laparoscopic cholecystectomy

  • Karla V. Chávez
  • Horacio Márquez-González
  • Itzé Aguirre
  • Juan C. Orellana
Original Article


Laparoscopic cholecystectomy (LC) is the gold standard technique for the treatment of gallbladder disease. However, in some cases, conversion to open surgery is still necessary. Identification of patients with high risk of conversion is of great importance to prepare the surgical scenario and to anticipate the convalescence. The objective of this study is to identify the factors that may predict a conversion to an open procedure. A total of 1386 LC were performed in Dr. Manuel Gea González General Hospital, from January 2009 to May 2013. A retrospective analysis of 41 parameters in these patients was performed, including demographic variables, clinical history, laboratory studies, ultrasound results and intraoperative findings. Subsequently, a multivariate logistic regression analysis was used to determine the predictive variables for conversion. Fourteen patients required conversion (1%). The multivariate analysis revealed that the factor that was most associated with conversion was emergency surgery (OR 4.9, CI 95% 2.3–2.4), as well as dilatation > 6 mm of the common bile duct in ultrasound (OR 1.8, CI 95% 1.1–1.7), hepatomegaly (OR 1.3, CI 95% 0.3–4.9), diagnosis of chronic cholecystitis associated to previous biliary colics (OR 2.8, CI 95% 1.0–21) and elevated alanine aminotransaminase (OR 1.2, CI 95% 1.0–2.1). Patients with acute symptoms, with dilatation of the bile duct, cholestasis history and hepatomegaly have a higher risk of a conversion surgery. These factors may warn both the patient and the surgeon for a complex surgery and possible complications.


Laparoscopic cholecystectomy Conversion surgery Endoscopic cholecystectomy 


Compliance with ethical standards

Conflict of interest

All authors declared that they have no potential conflict of interest.

Ethical approval

All procedures performed in the participants of our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent was not required.


  1. 1.
    Keus F, de Jong J, Gooszen HG, Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD006231 Google Scholar
  2. 2.
    Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211. doi: 10.1016/j.amjsurg.2004.06.013 CrossRefPubMedGoogle Scholar
  3. 3.
    Bingener-Casey J, Richards ML, Strodel WE et al (2002) Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 6(6):800–805CrossRefPubMedGoogle Scholar
  4. 4.
    Kanaan SA, Murayama KM, Merriam LT et al (2002) Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res 106:20–24CrossRefPubMedGoogle Scholar
  5. 5.
    van der Steeg HJJ, Alexander S, Houterman S et al (2011) Risk factors for conversion during laparoscopic cholecystectomy—experiences from a general teaching hospital. Scand J Surg 100:169–173CrossRefPubMedGoogle Scholar
  6. 6.
    Kama NA, Kologlu M, Doganay M et al (2001) A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 181:520–525. doi: 10.1016/S0002-9610(01)00633-X CrossRefPubMedGoogle Scholar
  7. 7.
    Uecker J, Adams M, Skipper K, Dunn E (2001) Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach? Am Surg 67:637–640PubMedGoogle Scholar
  8. 8.
    Angrisani L, Lorenzo M, De Palma G et al (1995) Laparoscopic cholecystectomy in obese patients compared with nonobese patients. Surg Laparosc Endosc 5:197–201PubMedGoogle Scholar
  9. 9.
    Ammori BJ, Vezakis A, Davides D et al (2001) Laparoscopic cholecystectomy in morbidly obese patients. Surg Endosc 15:1336–1339. doi: 10.1007/s004640000019 CrossRefPubMedGoogle Scholar
  10. 10.
    Karayiannakis AJ, Polychronidis A, Perente S et al (2004) Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Surg Endosc 18:97–101. doi: 10.1007/s00464-003-9001-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Diez J, Delbene R, Ferreres A (1998) The feasibility of laparoscopic cholecystectomy in patients with previous abdominal surgery. HPB Surg 10:353–356CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rosen M, Brody F, Ponsky J (2002) Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 184:254–258CrossRefPubMedGoogle Scholar
  13. 13.
    Schäfer M, Krähenbühl L, Büchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182:291–297CrossRefPubMedGoogle Scholar
  14. 14.
    Alponat A, Kum CK, Koh BC et al (1997) Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 21(6):629–633CrossRefPubMedGoogle Scholar
  15. 15.
    O’Leary DP, Myers E, Waldron D, Coffey JC (2013) Beware the contracted gallbladder—ultrasonic predictors of conversion. Surgeon 11:187–190. doi: 10.1016/j.surge.2012.11.001 CrossRefPubMedGoogle Scholar
  16. 16.
    Poggio JL, Rowland CM, Gores GJ et al (2000) A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease. Surgery 127:405–411CrossRefPubMedGoogle Scholar
  17. 17.
    Clark JR, Wills VL, Hunt DR (2001) Cirrhosis and laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 11:165–169CrossRefPubMedGoogle Scholar
  18. 18.
    Tate JJ, Lau WY, Li AK (1994) Laparoscopic cholecystectomy for biliary pancreatitis. Br J Surg 81:720–722CrossRefPubMedGoogle Scholar
  19. 19.
    Antoniou SA, Antoniou GA, Makridis C (2010) Laparoscopic treatment of Mirizzi syndrome: a systematic review. Surg Endosc 24:33–39. doi: 10.1007/s00464-009-0520-5 CrossRefPubMedGoogle Scholar
  20. 20.
    Wysocki A, Bobrzynski A, Krzywon J, Budzynski A (1999) Laparoscopic cholecystectomy and gallbladder cancer. Surg Endosc 13:899–901CrossRefPubMedGoogle Scholar
  21. 21.
    Cagir B, Rangraj M, Maffuci L, Herz BL (1994) The learning curve for laparoscopic cholecystectomy. J Laparoendosc Surg 4:419–427CrossRefPubMedGoogle Scholar
  22. 22.
    MacFadyen BV, Vecchio R, Ricardo AE, Mathis CR (1998) Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 12:315–321CrossRefPubMedGoogle Scholar
  23. 23.
    Meyers WC (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324:1073–1078. doi: 10.1056/NEJM199104183241601 CrossRefGoogle Scholar
  24. 24.
    Sain AH (1996) Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg 224:689–690CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lengyel BI, Panizales MT, Steinberg J et al (2012) Laparoscopic cholecystectomy: what is the price of conversion? Surgery (United States) 152:173–178. doi: 10.1016/j.surg.2012.02.016 Google Scholar
  26. 26.
    Le VH, Smith DE, Johnson BL (2012) Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. Am Surg 78:1392–1395. doi: 10.1016/j.optlaseng.2003.08.005 PubMedGoogle Scholar
  27. 27.
    Yajima H, Kanai H, Son K et al (2014) Reasons and risk factors for intraoperative conversion from laparoscopic to open cholecystectomy. Surg Today 44:80–83. doi: 10.1007/s00595-012-0465-5 CrossRefPubMedGoogle Scholar
  28. 28.
    Liu CL, Fan ST, Lai EC et al (1996) Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 131:98–101CrossRefPubMedGoogle Scholar
  29. 29.
    Yang TF, Guo L, Wang Q (2014) Evaluation of preoperative risk factor for converting laparoscopic to open cholecystectomy: a meta-analysis. Hepatogastroenterology 61:958–965PubMedGoogle Scholar
  30. 30.
    Ho HS, Mathiesen KA, Wolfe BM (1996) The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis. Surg Endosc 10:746–750CrossRefPubMedGoogle Scholar
  31. 31.
    Hutchinson CH, Traverso LW, Lee FT (1994) Laparoscopic cholecystectomy. Do preoperative factors predict the need to convert to open? Surg Endosc 8:875–878CrossRefPubMedGoogle Scholar
  32. 32.
    Sakpal SV, Bindra SS, Chamberlain RS (2010) Laparoscopic cholecystectomy conversion rates two decades later. JSLS 14:476–483. doi: 10.4293/108680810X12924466008240 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Tiong L, Oh J (2015) Safety and efficacy of a laparoscopic cholecystectomy in the morbid and super obese patients. HPB 17:600–604. doi: 10.1111/hpb.12415 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  1. 1.Endoscopic Surgery DepartmentHospital General “Dr. Manuel Gea González”Mexico CityMexico
  2. 2.Congenital Heart Disease DepartmentHospital de Cardiología Centro Médico Nacional “Siglo XXI”Mexico CityMexico

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