Central Surgical Association| Volume 142, ISSUE 4, P556-565, October 2007

Preoperative findings predict conversion from laparoscopic to open cholecystectomy


      Previous studies evaluating predictive factors for conversion from laparoscopic to open cholecystectomy have drawn conflicting conclusions. We evaluated objective preoperative variables to create an accurate, accessible risk score to predict conversion.


      A retrospective review was performed of laparoscopic cholecystectomy patients at an urban tertiary care center. Seventy characteristics were subjected to bivariate and multivariate logistic regression analysis to identify parameters that independently predict conversion to open cholecystectomy. A model was created based on this analysis.


      Laparoscopic cholecystectomy was performed on 1377 patients for benign gallbladder disease over a 71-month period. There were 112 (8.1%) conversions to open cholecystectomy. The correlation between the preoperative clinical diagnosis and pathologic diagnosis for acute and chronic cholecystitis was 48.6% and 94.6%, respectively. Multivariate analysis identified male gender, elevated white blood cell count, low serum albumin, ultrasound finding of pericholecystic fluid, diabetes mellitus, and elevated total bilirubin as independent predictors of conversion. These 6 factors were also associated with the pathologic diagnosis of acute cholecystitis. A model to calculate the risk for conversion was created with an area under the receiver operator curve of 0.83. The risk for conversion also can be estimated based on the number of factors identified present and ranged from 2% when 1 factor was present to 89% with 6 factors.


      These results demonstrate that conversion to open cholecystectomy can be predicted based on parameters available preoperatively. Conversion is more likely in patients who have acute cholecystitis; however, the correlation between its clinical and pathologic diagnosis is poor. Improvements in the ability to determine the risk for conversion have important implications for surgical care.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Livingston E.
        • Rege R.
        A nationwide study of conversion from laparoscopic to open cholecystectomy.
        Am J Surg. 2004; 188: 205-211
        • Alponat A.
        • Kum C.
        • Koh B.
        • Rajnakova A.
        • Goh P.
        Predictive factors for conversion of laparoscopic cholecystectomy.
        World J Surg. 1997; 21: 629-633
        • Fried G.
        • Barkun J.
        • Sigman H.
        • Joseph L.
        • Clas D.
        • Garzon J.
        • et al.
        Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy.
        Am J Surg. 1994; 167: 35-39
        • Kama N.
        • Kologlu M.
        • Doganay M.
        • Reis E.
        • Atli M.
        • Dolapci M.
        A risk score for conversion from laparoscopic to open cholecystectomy.
        Am J Surg. 2001; 181: 520-525
        • Tang B.
        • Cuschieri A.
        Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome.
        J Gastrointest Surg. 2006; 10: 1081-1091
        • Bulbuller N.
        • Ilhan Y.
        • Baktir A.
        • Kirkil C.
        • Dogru O.
        Implementation of a scoring system for assessing difficult cholecystectomies in a single center.
        Surg Today. 2006; 36: 37-40
        • Wiebke E.
        • Pruitt A.
        • Howard T.
        • Jacobson L.
        • Broadie T.
        • Goulet Jr, R.J.
        • et al.
        Conversion of laparoscopic to open cholecystectomy.
        Surg Endosc. 1996; 10: 742-745
        • Ibrahim S.
        • Hean T.
        • Ho L.
        • Ravintharan T.
        • Chye T.
        • Chee C.
        Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy.
        World J Surg. 2006; 30: 1698-1704
        • Simopoulos C.
        • Botaitis S.
        • Polychronidis A.
        • Tripsianis G.
        • Karayiannakis A.
        Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.
        Surg Endosc. 2005; 19: 905-909
        • Rosen M.
        • Brody F.
        • Ponsky J.
        Predictive factors for conversion of laparoscopic cholecystectomy.
        Am J Surg. 2002; 184: 254-258
        • Z’graggen K.
        • Wehrli H.
        • Metzger A.
        • Buehler M.
        • Frei E.
        • Klaiber C.
        Complications of laparoscopic cholecystectomy in Switzerland.
        Surg Endosc. 1998; 12: 1303-1310
        • Zisman A.
        • Gold-Deutch R.
        • Zisman E.
        • Negri M.
        • Halpern Z.
        • Lin G.
        • et al.
        Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?.
        Surg Endosc. 1996; 10: 892-894
        • Schafer M.
        • Krahenbuhl L.
        • Buchler M.
        Predictive factors for the type of surgery in acute cholecystitis.
        Am J Surg. 2001; 182: 291-297
        • Kanaan S.
        • Murayama K.
        • Merriam L.
        • Dawes L.
        • Prystowsky J.
        • Rege R.
        • et al.
        Risk factors for conversion of laparoscopic to open cholecystectomy.
        J Surg Res. 2002; 106: 20-24
        • Brodsky A.
        • Matter I.
        • Sabo E.
        • Cohen A.
        • Abrahamson J.
        • Eldar S.
        Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted?.
        Surg Endosc. 2000; 14: 755-760
        • Halachmi S.
        • DiCastro N.
        • Matter I.
        • Cohen A.
        • Sabo E.
        • Mogilner J.
        • et al.
        Laparoscopic cholecystectomy for acute cholecystitis: how do fever and leucocytosis relate to conversion and complications?.
        Eur J Surg. 2000; 166: 136-140
        • Schrenk P.
        • Woisetschlager R.
        • Rieger R.
        • Wayand W.
        A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables.
        Surg Endosc. 1998; 12: 148-150
        • Bedirli A.
        • Sozuer E.
        • Yuksel O.
        • Yilmaz Z.
        Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients.
        J Laparoendosc Adv Surg Tech A. 2001; 11: 281-284
        • Shpitz B.
        • Sigal A.
        • Kaufman Z.
        • Dinbar A.
        Acute cholecystitis in diabetic patients.
        Am Surg. 1995; 61: 964-967
        • Lau H.
        • Lo C.
        • Patil N.
        • Yuen W.
        Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis.
        Surg Endosc. 2006; 20: 82-87
        • Rohatgi A.
        • Singh K.
        Mirizzi syndrome: laparoscopic management by subtotal cholecystectomy.
        Surg Endosc. 2006; 20: 1477-1481
        • Kauvar D.
        • Braswell A.
        • Brown B.
        • Harnisch M.
        Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy.
        J Surg Res. 2006; 132: 159-163
        • Imhof M.
        • Zacherl J.
        • Rais A.
        • Lipovac M.
        • Jakesz R.
        • Fuegger R.
        Teaching laparoscopic cholecystectomy: do beginners adversely affect the outcome of the operation?.
        Eur J Surg. 2002; 168: 470-474
        • Shea J.
        • Healey M.
        • Berlin J.
        • Clarke J.
        • Malet P.
        • Staroscik R.
        • et al.
        Mortality and complications associated with laparoscopic cholecystectomy.
        Ann Surg. 1996; 224: 609-620
        • Shamiyeh A.
        • Wayand W.
        Laparoscopic cholecystectomy: early and late complications and their treatment.
        Langenbecks Arch Surg. 2004; 389: 164-171