ArticleSurgical endoscopy2022
Open conversion in laparoscopic cholecystectomy and bile duct exploration: subspecialisation safely reduces the conversion rates.
Article in Surgical endoscopy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis.Korean journal of anesthesiology · 2023Pooled it
- Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy-a systematic review.World journal of emergency surgery : WJES · 2021Pooled it
- The Effect of Various Combinations of Peripheral Nerve Blocks on Postoperative Pain in Laparoscopic Cholecystectomy: A Comparative Prospective Study.International journal of clinical practice · 2023Trial
- Erector spinae plane block in laparoscopic cholecystectomy: cutting pain, not just gallbladder (systematic review and meta-analysis of randomized controlled trials).International journal of surgery (London, England) · 2026Article
- Navigating the Impossible Gallbladder: Bailout Strategies and Culture of Safety in Laparoscopic Cholecystectomy.Cureus · 2026Review
- Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy surgery across England: an observational study using administrative data.Surgical endoscopy · 2026Observational
- Feasibility and learning curve of a standardized laparoscopic cholecystectomy technique using a reusable bipolar device: a risk-adjusted CUSUM analysis of 780 cases operated by surgical trainees.Surgical endoscopy · 2025Article
- A new framework for tailoring laparoscopic cholecystectomy: Integrating preoperative clinical factors with surgical difficulty based on the Tokyo Guidelines 2018.Journal of hepato-biliary-pancreatic sciences · 2025Article
- Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study.Scientific reports · 2025Article
- Single-stage laparoendoscopic management of cholecystocholedocholithiasis: A retrospective study comparing starting with ERCP versus with laparoscopic cholecystectomy.Annals of hepato-biliary-pancreatic surgery · 2025Article
- Laparoscopic Subtotal Cholecystectomy for Difficult Gallbladders: Single-Center Retrospective Cohort Study.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2025Article
- Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence.Surgery today · 2024Article
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- Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study.Biomedical reports · 2024Article
- Association of severe obesity with risk of conversion to open in laparoscopic cholecystectomy for acute cholecystitis.Surgery open science · 2024Article
- The effects of previous abdominal surgery and the utilisation of modified access techniques on the operative difficulty and outcomes of laparoscopic cholecystectomy and bile duct exploration.Surgical endoscopy · 2024Article
- Letter to the Editor RE: "A bifid gallbladder? A challenging laparoscopic cholecystectomy".International journal of surgery case reports · 2024Article
- Preoperative diagnostic criteria for scleroatrophic gallbladder: A systematic review protocol.PloS one · 2024Article
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Authors and funding
5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundOpen conversion rates during laparoscopic cholecystectomy vary depending on many factors. Surgeon experience and operative difficulty influence the decision to convert on the grounds of patient safety but occasionally due to technical factors. We aim to evaluate the difficulties leading to conversion, the strategies used to minimise this event and how subspecialisation influenced conversion rates over time.
methodsProspectively collected data from 5738 laparoscopic cholecystectomies performed by a single surgeon over 28 years was analysed. Routine intraoperative cholangiography and common bile duct exploration when indicated are utilised. Patients undergoing conversion, fundus first dissection or subtotal cholecystectomy were identified and the causes and outcomes compared to those in the literature.
results28 patients underwent conversion to open cholecystectomy (0.49%). Morbidity was relatively high (33%). 16 of the 28 patients (57%) had undergone bile duct exploration. The most common causes of conversion in our series were dense adhesions (9/28, 32%) and impacted bile duct stones (7/28, 25%). 173 patients underwent fundus first cholecystectomy (FFC) (3%) and 6 subtotal cholecystectomy (0.1%). Morbidity was 17.3% for the FFC and no complications were encountered in the subtotal cholecystectomy patients. These salvage techniques have reduced our conversion rate from a potential 3.5% to 0.49%.
conclusionAlthough open conversion should not be seen as a failure, it carries a high morbidity and should only be performed when other strategies have failed. Subspecialisation and a high emergency case volume together with FFC and subtotal cholecystectomy as salvage strategies can reduce conversion and its morbidity in difficult cholecystectomies.
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