Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for convers
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RESEARCH ARTICLE
Open Access
Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications Petra Maria Terho1, Ari Kalevi Leppäniemi2 and Panu Juhani Mentula2*
Abstract Background: The purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified. Methods: A total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used. Results: Laparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications. Conclusions: Advanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes. Keywords: Acute cholecystitis, Laparoscopic cholecystectomy, Open cholecystectomy, Conversion
Background Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis [1, 2]. LC has been linked to a lower complication rate and shorter postoperative hospital stay compared with open cholecystectomy (OC) [3, 4]. Performing early cholecystectomy on patients admitted for acute cholecystitis is preferable to postponing the operation to be performed when the acute phase is over, since an early procedure has been recognized to
* Correspondence: [email protected] 2 Department of Abdominal Surgery, Helsinki University Central Hospital, P.O.Box 340, 00029 HUS Helsinki, Finland Full list of author information is available at the end of the article
shorten postoperative hospital stay and lower hospital care expenses [5, 6]. Gallbladder disease is among the leading causes for hospital admission for acute abdomen among adults and the most common indication for abdominal surgery in the elderly [7, 8]. In situations when LC is unsafe the surgeon might have to convert to an open procedure. The risk of conversion is higher in LC for acute cholecystitis than it is in an elective procedure [9].
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