Assessment of Pre-Operative Predictive Factors Favoring Conversion from Laparoscopic to Open Cholecystectomy in Acute Cholecystitis

Abstract Background Acute cholecystitis refers to inflammation of the gallbladder. The pathophysiologic mechanism of acute cholecystitis is blockage of the cystic duct. Accurate diagnosis of cholecystitis requires a multifactorial, systematic approach that involves a detailed history, physical exam, serologic tests, and imaging. The (Tokyo guidelines 2018) diagnostic criteria for acute cholecystitis is widely used now days and well accepted. Objective To asses pre-operative predictive factors favoring conversion of laparoscopic cholecystectomy into open cholecystectomy in acute cholecystitis such as: (TLC- history of DM and previous abdominal surgery -gall bladder wall thickness _ pericholecystic fluid collection and loss of gallbladder wall enhancement on CT). Patients and Methods This study included 100 patients admitted to Ain Shams university hospitals diagnosed with acute cholecystitis, underwent laparoscopic cholecystectomy, half of them converted to open cholecystectomy, the two groups are compared to each other to figure out preoperative factors favoring conversion cholecystectomy Results Obesity (BMI≥30 kg/m2) in this study has shown to be associated with risk of conversion in this study. In converted group there is 25 (50%) patients who are obese compared to 14 (28%) patients in laparoscopic group with P-value of 0.04. In our study we haven’t assessed the role of intraoperative findings on conversion rate. We chose not to include this factor in our analysis to make primary concern regarding pre-operative factors. Conclusion Obesity, DM, previous abdominal surgery, loss of gallbladder wall enhancement in CT study and prolonged prothrombin time are risk factors of conversion cholecystectomy in acute cholecystitis. Appropriate management of risk-related preoperative factors may improve patients’ outcomes making in mind the concept of conversion to open cholecystectomy should not be viewed as a complication or a failure but just the opposite. It is showing good judgment to complete the operation in the safest manner possible.