Factors predisposing to conversion from laparoscopic to open cholecystectomy
The conversion of a laparoscopic cholecystectomy (LC) to an open procedure seems to be multifactorial, be affected by factors related to the patient, the gallbladder’s pathology and the surgeon. Among the more than twenty parameters which have been studied as possible predisposing factors for conversion, current literature addresses that: a male patient, above 65 years old, with American Society of Anaesthesiology (ASA) score ≥3, suffering from acute cholecystitis, with a thickened gallbladder’s wall on preoperative CT and an impacted stone in infundibulum or Mirizzi syndrome as intraoperative finding, who was operated on more than 72 hours from the onset of symptoms, by a non-laparoscopic surgeon, represents the most likely candidate for conversion from LC to open surgery. The probability increases further in the presence of malnutrition and/or cirrhosis. The proposed predictive scores for conversion have not yet found worldwide acceptance and their use is limited to theoretical or training purposes. Even patients with maximum predictive score, do not have a 100% probability for conversion. An experienced surgeon can complete a difficult LC successfully in high-risk surgical patient using the subtotal LC. The need for conversion to laparotomy should be considered as neither a failure nor a complication, but as an attempt to be avoided intra- or post-operative complications. The present review attempts to present the most recent knowledge on the field “conversion from LC to open surgery”.