Laparoscopic cholecystectomy - review over 20 years with attention on acute cholecystitis and conversion*

BACKGROUND: The first laparoscopic cholecystectomy (LC) in Austria was performed on March 22nd, 1990 at the General Hospital Linz. As the experience increased during time the scope of contraindications has been narrowed and the rate of conversion has been decreased. However, acute cholecystitis still leads to a higher conversion rate. METHODS: We retrospectively analysed all cholecystectomies from 1990 till 2010. All acute cholecystectomies have been carried out with regard to conversion, risk factors for conversion, morbidity and mortality. RESULTS: We performed 7541 cholecystectomies. 701 (9.3%) patients had primary open cholecystectomy (OC) and 452 (6%) had concomitant CHE without further evaluation for this study. From the remaining 6139 patients with LC 1775 (male 885 [36%], female 890 [21%]) have been operated due to acute cholecystitis. 141 (7.9%, 78 male, 63 female, median age 66 years, range 20-94) of them led to conversion. The acute inflammation itself including difficulties in Calot's triangle was the most common cause for conversion (56%) followed by adhesions (19.1%). Two patients have been converted due to common bile duct lesion (1.4%) In case of acute operation and conversion the mortality was 5%, morbidity was 20%. Out of the 4364 patients with elective LC 200 had to be converted (4.6%). The overall conversion rate was 5.5%. The Reoperation rate after conversion was 6.3% (n = 9). CONCLUSIONS: Acute cholecystitis leads significantly more often to conversion as in elective LC. Male patients present at the clinic more frequent than female with acute cholecystitis, but in the acute situation the conversion rate is equal.