Conversion After More Than Two Hours Increases the Risk of Major Complication in Patients with Acute Cholecystitis Approached Laparoscopically

Aim: The aim of this study was to evaluate whether the length of the laparoscopic time before the decision to convert during laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) has any impact on the patients’ course. Methods: Medical records of 3832 patients undergone LC for AC during the last fifteen years in our unit, were retrospectively analyzed. 71 of these (1.9%) were converted to open. We divided them into two groups: G1 (n=52, 73%) included patients who had conversion within 2 h from the beginning of the operation, and G2 (n=19, 27%) included patients converted after more than 2 h of laparoscopy. We analyzed and compared the following parameters: patients’ general characteristic (age, gender, BMI, ASA score), rate of gangrenous acute cholecystitis, mean operative time, mean length of postoperative stay, morbidity and mortality. Morbidity was graded according to Clavien and Dindo classification. A p value<0.05 was considered significant. Results: 71 LC were converted for severe inflammation (33, 46%), strength visceral adhesions (19, 27%), inability to remove stones from common biliary duct (10, 14%), pneumoperitoneum intolerance (6, 9%), duodenal injuries (2, 3%) and arterial bleeding (1, 1%). Between G1 and G2, F/M ratio (11/33 vs 5/14, p=0.57) and mean BMI (25.3 vs 27.4 kg/m2, p=0.09) were not significantly different. Conversely, there was a significant difference in terms of age (mean, 71 vs 63.4 yrs, p=0.03) and ASA score (mean, 2.44 vs 2, p=0.01). Mean operative time was 174.5 in G1 and 235.2 in G2 patients. The rate of gangrenous cholecystitis was 38% in G1 and 21% in G2 (p=0.25). There were no significant differences regarding overall morbidity (26.9% vs 36.8%, p=0.41), mortality (2% vs 5%, p=0.45), and post-operative stay (mean 8.69 vs 8.27 days, p=0.41). However, major complications (grade III-V according to Clavien and Dindo classification) were 28% in G1 and 86% in G2 (p=0.02). Conclusion: In patients with AC, a laparoscopic time lasting more than 2 h before conversion seems to be linked to the occurrence of major complications, although it does not affect mortality and length of hospital stay