Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted

• Published in: Langenbeck's archives of surgery Vol. 401; no. 4; pp. 479 - 488
• Main Authors: Spohnholz, Johannes, Herzog, Torsten, Munding, Johanna, Belyaev, Orlin, Uhl, Waldemar, Braumann, Chris, Chromik, Ansgar Michael
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2016
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Cardiac Surgery; Cholecystectomy, Laparoscopic; Cholecystitis, Acute - pathology; Cholecystitis, Acute - surgery; Conversion to Open Surgery; Female; General Surgery; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Selection; Retrospective Studies; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Young Adult; Conversion cholecystectomy; Gallbladder; Laparoscopy; Cholelithiasis; Acute cholecystitis
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-016-1394-3

Background Although laparoscopic cholecystectomy is recommended as standard treatment for acute cholecystitis, in 10–30 % a conversion to open cholecystectomy is required. Among some surgeons, this is still perceived as a “complication.” The aim of our study was to define characteristics and outcome of patients with acute cholecystitis undergoing conversion cholecystectomy. Methods Over a 9-year period, 464 consecutive patients undergoing cholecystectomy for acute cholecystitis were analyzed for demographic, preoperative, intraoperative, histopathological, and laboratory findings and surgical outcome parameters. Results Patients with conversion cholecystectomy were characterized by younger age, lower American Society of Anesthesiologists (ASA) score, and less cardiac comorbidities compared to patients with primary open cholecystectomy. Severity of inflammation on the clinical and histopathological level was similar and comparable. Overall complication rate, mortality, and median hospital stay were significantly lower compared to those of primary open cholecystectomy group. Conclusions There are no disadvantages for patients undergoing conversion cholecystectomy compared to primary open cholecystectomy. The outcome is influenced by general condition and comorbidities rather than by the surgical approach. Underlying fear of conversion should not avoid a laparoscopic approach in patients with acute cholecystitis.