Influencing factors of conversion from laparoscopic surgery to laparotomy in patients with acute calculous cholecystitis

Objective To analyze the influencing factors of conversion from laparoscopic surgery to laparotomy in patients with acute calculous cholecystitis.Methods 600 patients with acute calculous cholecystitis treated by laparoscopic surgery in the hospital were selected.According to the time interval from the onset of clinical symptoms to laparoscopic surgery,the patients were divided into group A (within 48 hours after onset),group B (48 hours after onset) and group C (1-2 weeks after symptom relief),with 200 cases in each group.The duration of surgery,intraoperative blood loss,postoperative drainage volume,the incidence of complications and the rate of conversion to laparotomy were recorded.Patients undergoing laparotomy were included into the observation group and the others were included into the control group.The clinical data were compared between the two groups,and the independent risk factors for conversion to laparotomy were analyzed.Results The surgical time,intraoperative blood loss and postoperative abdominal drainage volume of group B were significantly longer or more than those of group A and those of group C (P＜0.05).The rate of conversion to laparotomy and the incidence of complications were lower in group A than in group B or in group C (P＜0.05).The body temperature,white blood cell count,thickness of gallbladder wall,surgical time,incidence rates of gallbladder neck calculi incarceration and gallbladder enlargement were significantly higher,thicker or longer in the observation group than in the control group (P＜0.05).Logistic regression analysis showed that white blood cell count,timing of surgery and gallbladder neck calculi incarceration were independent risk factors for conversion to laparotomy (P＜0.05).Conclusion Within 48h after the onset of acute calculous cholecystitis is the best timing for laparoscopic surgery.White blood cell count,timing of surgery and gallbladder neck calculi incarceration are independent risk factors for conversion to laparotomy,which should be considered to improve the success rate of laparoscopic surgery.