Identifying the Prognostic Factors Affecting the Conversion From Laparoscopic Cholecystectomy to Open Cholecystectomy in Acute Cholecystitis

Introduction Acute cholecystitis, commonly caused by gallstones, is a prevalent surgical emergency worldwide. Laparoscopic cholecystectomy (LC) is the gold standard for treatment, but the timing is crucial, with early surgery (within seven days) reducing complications. Identifying prognostic factors such as age, sex, white blood cell (WBC) count, C-reactive protein (CRP), and gallbladder wall thickness can help predict outcomes and reduce the need for conversion to open surgery. Methods A prospective longitudinal observational study was conducted at Sree Balaji Medical College and Hospital, Chennai, on 60 patients diagnosed with acute cholecystitis. The inclusion criteria involved clinical signs (right upper abdominal tenderness, temperature >37.5°C, WBC >10,000 cells/mm³) and ultrasound findings (gallstones, thickened gallbladder, sonographic Murphy's sign). Data on prognostic factors (WBC, CRP, ultrasound, intraoperative findings) were collected and analyzed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, New York, United States), with chi-squared tests to evaluate associations between these factors and surgical outcomes. Results Patients aged 18-30 had the highest success rate for early LC, with only 10.5% converting to open surgery, whereas older patients (>50 years) had a higher conversion rate (33.3%). A higher body mass index (BMI) (>30) was linked to increased conversions (26.3%), as was the presence of hypertension (23.1%) and diabetes (22.2%). Elevated WBC and CRP levels were significant predictors of conversion (24.2% and 22.2%, respectively). Intraoperative factors such as gallbladder wall thickening (>4 mm) and pericholecystic fluid were associated with conversion rates of 20.8% and 25%, respectively. Converted cases had longer operative times and extended recovery periods. The predictive model for conversion showed a sensitivity of 88.9% and a specificity of 90%. Conclusion Key prognostic factors influencing the success of early LC include age, BMI, comorbidities, and inflammatory markers such as WBC and CRP. Younger patients had higher success rates, whereas older and obese patients were at greater risk of conversion. Preoperative optimization and early surgical intervention are critical for reducing conversion rates and improving outcomes. The predictive model's accuracy provides clinicians with a valuable tool for surgical planning.