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Vol. 89. Issue 5.
Pages 300-306 (May 2011)
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Vol. 89. Issue 5.
Pages 300-306 (May 2011)
DOI: 10.1016/S2173-5077(11)70038-2
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Analysis of factors for conversion of laparoscopic to open cholecystectomy: A prospective study of 703 patients with acute cholecystitis
Análisis de los factores de conversión durante colecistectomía laparoscópica a abierta en una cohorte prospectiva de 703 pacientes con colecistitis aguda
Luis C. Domíngueza,b,
Corresponding author

Corresponding author.
, Aura Riveraa, Charles Bermúdeza, Wilmar Herreraa
a Departamento de Cirugía, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
b Universidad de la Sabana, Chía, Colombia
Article information

Conversions to open surgery during laparoscopic cholecystectomy are performed in 20% of patients with acute cholecystitis, and are associated with increased morbidity and costs. The aim of this study was to identify predictive factors for conversion and to evaluate morbidity, mortality and hospital stay.


A prospective cohort of patients admitted to the emergency department with acute cholecystitis. We evaluated the statistical significance of the demographic, clinical, biochemical, imaging and surgical factors at admission, associated with conversion to open surgery using a univariate model. The associated factors evaluated during initial analysis were then included in a multivariate analysis. Finally a comparative analysis was made of the morbidity and mortality in both models.


A total of 703 patients were included. Conversion rate was 13.8%. Univariate analysis identified as factors: male gender, previous ERCP, leucocytes > 12,000mm3, age >70 years, hypertension, jaundice, cholangitis, total bilirubin >2mg/dl, ASA III-IV, gallbladder wall enlargement and choledocholithiasis. Logistic regression identified as predictive factors: previous ERCP, leucocytes, age >70 years and male gender. Converted patients had a higher morbidity rate, further operations and longer hospital stays (P<001). No difference was seen in mortality.


It is important to recognise patients with a higher risk of conversion in order to optimise planning and performing of the surgical procedure, and to decrease the morbidity associated with laparotomy, given that the independent factors identified are not modifiable.

Laparoscopic cholecystectomy
Risk factors
Hospital stay

La conversión a cirugía abierta durante colecistectomía laparoscópica se presenta en el 20%. Este desenlace se relaciona con mayor morbilidad y costos. En este estudio se describen los factores predictivos de conversión, la estancia hospitalaria, morbimortalidad asociada.

Materiales y métodos

Cohorte prospectiva de pacientes sometidos a colecistectomía laparoscópica de urgencia con colecistitis aguda. Análisis uni- y multivariado de los factores predictivos de conversión a partir de variables socio-demográficas, clínicas, bioquímicas y de imágenes diagnósticas, identificación de la tasa de morbilidad, mortalidad y estancia hospitalaria en los dos grupos.


703 pacientes fueron incluidos en el análisis. La tasa de conversión fue 13,8%. Los factores identificados en el análisis univariado fueron: género masculino, edad > 70 años, hipertensión arterial, colangitis, CPRE previa, coledocolitiasis, bilirrubina total > 2 mg/dl, ictericia, recuento de leucocitos >12.000 mm3, ASA III-IV y engrosamiento de la pared de la vesícula por ecografía. Los factores independientes fueron: género masculino (p<0,02), edad>70 años (p < 0,02), CPRE previa (p < 0,05) y recuento de leucocitos> 12.000mm3 (p < 0,04). Los pacientes convertidos presentaron mayor tasa de morbilidad, reoperación y estancia hospitalaria (p < 0,001). La mortalidad no mostró diferencias.


Es importante reconocer al paciente con mayor riesgo de conversión para optimizar la planeación y ejecución del procedimiento quirúrgico y disminuir la morbilidad asociada a la laparotomía, dado que los factores independientes identificados no son modificables.

Palabras clave:
Colecistectomía laparoscópica
Factores de riesgo
Estancia hospitalaria
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E.A. Shaffer.
Gallstone disease: epidemiology of gallbladder stone disease.
Best Pract Res Clin Gastroenterol, 20 (2006), pp. 981-996
L.M. Stinton, R.P. Myers, E.A. Shaffer.
Epidemiology of Gallstones.
Gastroenterol Clin North Am, 39 (2010), pp. 157-169
R.P. Nenner, P.J. Imperato, C. Rosenberg, E. Ronberg.
Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy.
J Community Health, 19 (1994), pp. 409-415
A.P. Legorreta, J.H. Silber, G.N. Costantino, R.W. Kobylinski, S.L. Zatz.
Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy.
JAMA, 270 (1993), pp. 1429-1432
J.E. Everhart, C.E. Ruhl.
Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases.
Gastroenterology, 136 (2009), pp. 376-386
R. Villeta Plaza, J.I. Landa García, E. Rodríguez Cuéllar, J. Alcalde Escribano, P. Ruiz López.
National project for the clinical management of healthcare processes. The surgical treatment of cholelithiasis. Development of a clinical pathway.
Cir Esp, 80 (2006), pp. 307-325
H.M. Kaafarani, T.S. Smith, L. Neumayer, D.H. Berger, R.G. Depalma, K.M. Itani.
Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals.
Am J Surg, 200 (2010), pp. 32-40
F. Keus, J.A. De Jong, H.G. Gooszen, C.J. Van Laarhoven.
Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.
Cochrane Database Syst Rev, (2006),
G. Berci, J. Sackier.
The Los Angeles experience with laparoscopic cholecystectomy.
Am J Surg, 161 (1991), pp. 382-384
A. Cuschieri, F. Dubois, J. Mouiel, P. Mouret, H. Becker, G. Buess, et al.
The European experience with laparoscopic cholecystectomy.
Am J Surg, 161 (1991), pp. 385-387
P.B. Lai, K.H. Kwong, K.L. Leung, S.P. Kwok, A.C. Chan, S.C. Chung, et al.
Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
D.W. Rattner, C. Ferguson, A.L. Warshaw.
Factors associated with successfullaparoscopic cholecystectomy for acute cholecystitis.
Ann Surg, 217 (1993), pp. 233-236
M. Rosen, F. Brody, J. Ponsky.
Predictive factors for conversion of laparoscopic cholecystectomy.
Am J Surg, 184 (2002), pp. 254-258
N.A. Kama, M. Kologlu, M. Doganay, E. Reis, M. Atli, M. Dolapei.
A risk score for conversion from laparoscopic to open cholecystectomy.
Am J Surg, 181 (2001), pp. 520-525
G.M. Fried, J.S. Barkun, H.H. Sigman, L. Joseph, D. Clas, J. Garzon, et al.
Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy.
Am J Surg, 164 (1994), pp. 35-41
M.A. Martínez, J. Ruiz, R. Torres, A. Fernández.
Laparoscopic cholecystectomy. Report of the first 1300 cases carried out by a multidisciplinary team.
Rev Gastroenterol Peru, 16 (1996), pp. 133-137
H. Orozco, M.A. Mercado, E. Prado.
Laparoscopic cholecystectomy First year experience at the Salvador Zubirán National Institute of Nutrition.
Rev Invest Clin, 45 (1993), pp. 223-227
J.C. Pattillo, R. Kusanovic, P. Salas, J. Reyes, I. García-Huidobro, M. Sanhueza, et al.
Outpatient laparoscopic cholecystectomy. Experience in 357 patients.
Rev Med Chil, 132 (2004), pp. 429-436
S.I. Hoyos, C. Cock, H. Restrepo.
Colecistectomía laparoscópica. Seguimiento de 514 casos.
Rev Colomb Cir, 13 (1998), pp. 261-264
L. Zuluaga, W. Clavijo, A. Tavera.
Colecistectomía laparoscópica ambulatoria en una unidad quirúrgica no hospitalaria.
Rev Colomb Cir, 15 (2000), pp. 2-7
L. Arango, A. Ángel, E. Mullet, M. Osorio, A. Chala, H. León, et al.
Colecistectomía por laparoscopia: siete años de experiencia 1992–1998.
Rev Colomb Cir, 15 (2000), pp. 1-5
J. Moore, S. Rodríguez, A. Roa, M. Girón, A.E. Sanabria, P. Rodríguez, et al.
Colecistectomia laparoscópica ambulatoria: modelo de programa costo-eficiente de cirugía laparoscópica.
Rev Colomb Cir, 19 (2004), pp. 43-53
J. Vergnaud, S. Penagos, C. Lopera, A. Herrera, A. Zerrate, J. Vásquez.
Colecistectomía laparoscópica: experiencia en hospital de segundo nivel.
Rev Colomb Cir, 15 (2000), pp. 8-13
A.J. Mangram, T.C. Horan, M.L. Pearson, L.C. Silver, W.R. Jarvis, Guideline for Prevention of Surgical Site Infection, 1999.
Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.
Am J Infect Control, 27 (1999), pp. 97-132
W.J. Zhang, J.M. Li, G.Z. Wu, K.L. Luo, Z.T. Dong.
Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy.
ANZ J Surg, 78 (2008), pp. 973-976
S. Ibrahim, T.K. Hean, L.S. Ho, T. Ravintharan, T.N. Chye, C.H. Chee.
Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy.
World J Surg, 30 (2006), pp. 1698-1704
S.E. Thesbjerg, K.M. Harboe, L. Bardram, J. Rosenberg.
Sex differences in laparoscopic cholecystectomy.
M. Rosenmüller, M.M. Haapamäki, P. Nordin, H. Stenlund, E. Nilsson.
Cholecystectomy in Sweden 2000–2003: A nationwide study on procedures, patient characteristics, and mortality.
BMC Gastroenterology, 143 (2007), pp. 7-35
M. Ballal, G. David, S. Willmott, D.J. Corless, M. Deakin, J.P. Slavin.
Conversion after laparoscopic cholecystectomy in England.
Surg Endosc, 42 (2008), pp. 712-717
K. Gurusamy, K. Samraj, C. Gluud, E. Wilson, B. Davidson.
Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
Br J Surg, 97 (2010), pp. 141-150
N.A. Kama, M. Kologlu, M. Doganay, E. Reis, M. Atli, M. Dolapci.
A risk score for conversion from laparoscopic to open cholecystectomy.
Am J Surg, 181 (2001), pp. 520-525
A. Brodsky, I. Matter, E. Sabo, A. Cohen, J. Abrahamson, S. Eldar.
Laparoscopic cholecystectomy foracute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study.
Surg Endosc, 14 (2000), pp. 755-760
C.H. Hutchinson, L.W. Traverso, F.T. Lee.
Laparoscopic cholecystectomy Do preoperative factors predict the need to convert to open?.
Surg Endosc, 8 (1994), pp. 875-880
N.A. Kama, M. Doganay, M. Dolapci, E. Reis, M. Atli, M. Kologlu.
Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery.
Surg Endosc, 15 (2001), pp. 965-968
U.F. Giger, J.M. Michel, I. Opitz, D.T. Inderbitzin, T. Kocher, L. Krahenbhul.
Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: Analysis of 22,953 consecutive cases from the Swiss association of laparoscopic and thoracoscopic surgery database.
J Am Coll Surg, 203 (2006), pp. 723-729
J. Pérez, A. Anselmi.
Estudio comparativo de la tasa de conversión de colecistectomía por laparoscopia en pacientes con extracción endoscópica previa de cálculos de la vía biliar y sin ella.
Rev Colomb Cir, 24 (2009), pp. 23-26
S. Eldar, H.T. Siegelmann.
Conversion of laparoscopic cholecystectomy to open cholecystectomy in acute cholecystitis: Artificial neural networks improve the prediction of conversion.
World J Surg, 26 (2002), pp. 79-85
S.W. Low, S. Ganpathi, S.T. Cullen.
Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates.
Surg Endosc, 112 (2009), pp. 21-27
P. Lal, P.N. Agarwal, V.K. Malik, A.L. Chakravarti.
A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography.
J Soc Laparoendoscopic Surg, 6 (2002), pp. 59-63
G. Srikanth, A. Kumar, R. Khare, L. Siddappa, A. Gupta, S.S. Sikora.
Should laparoscopic cholecystectomy be performed in patients with thick-walled gallbladder?.
J Hepatobiliary Surg, 11 (2004), pp. 40-44
C. Simopoulos, S. Botaitis, A. Polychronidis, A. Tripsianis, A.J. Karayiannakis.
Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.
Surg Endosc, 19 (2005), pp. 905-909
M.H. Thompson, J.R. Benger.
Cholecystectomy, conversion and complications.
HPB Surg, 11 (2000), pp. 373-378
J.A. Parra, J. Bueno, C. Madrazo, C. Fariñas, F. Torre, M.C. Fariñas.
Laparoscopic cholecystectomy: analysis of risk factors for predicting conversion to open cholecystectomy.
Rev Esp Enferm Dig, 91 (1999), pp. 359-364
E.H. Livingston, R.B. Rege, J.J. Thomas, L. Cooper.
A nationwide study of conversion from laparoscopic to open cholecystectomy.
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