Skip to main content
SpringerLink
Log in

Conversion after laparoscopic cholecystectomy in England

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic gallstones. Conversion to open surgery is reported to be necessary in 5–10% of cases. This study aimed to define those factors associated in English hospitals with the need to convert a laparoscopic cholecystectomy to an open procedure. These included patient-related and particularly nonpatient-related factors.

Methods

Using data derived from a national administrative database, Hospital Episode Statistics, patients undergoing cholecystectomy in acute National Health Service (NHS) hospitals in England during the financial years 2004–2006 were studied. The individual surgeon caseload and the hospital conversion rate were calculated using data from the first (baseline) year. Factors affecting the need for conversion were analyzed using data from the second (index) year.

Results

The study included 43,821 laparoscopic cholecystectomies undertaken from 2005 to 2006 in English hospitals. The overall conversion rate was 5.2%: 4.6% for elective procedures and 9.4% for emergency procedures. Patient-related factors that were good predictors of conversion included male sex, emergency admission, old age, and complicated gallstone disease (p < 0.001). Nonpatient-related factors that were good predictors of conversion included the laparoscopic cholecystectomy caseload of individual consultant surgeons and the overall hospital conversion rate in the previous year (all p < 0.001).

Conclusions

Conversion after laparoscopic cholecystectomy is less common as consultant caseload increases. This suggests that operation should be undertaken only by surgeons with an adequate caseload. There is a wide variation in conversion rates among hospitals. This has important implications for training as well as for the organization and accreditation of cholecystectomy services on a national basis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Muhe E (1986) The first cholecystectomy through the laparoscope. Langenbecks Arch Chir 396:804

    Article  Google Scholar 

  2. NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269:1018–1024

    Google Scholar 

  3. Wilson P, Leese T, Morgan WP, Kelly JF, Brigg JK (1991) Elective laparoscopic cholecystectomy for “all comers”. Lancet 338:795–797

    Article  CAS  PubMed  Google Scholar 

  4. Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL (1992) Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 340:1116–1119

    Article  CAS  PubMed  Google Scholar 

  5. McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, Sunderland G, Galloway D, Ramsay G, O’Dwyer PJ (1994) Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 343:135–138

    Article  CAS  PubMed  Google Scholar 

  6. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev CD006231

  7. Simopoulos C, Polychronidis A, Botaitis S, Perente S, Pitiakoudis M (2005) Laparoscopic cholecystectomy in obese patients. Obes Surg 15:243–246

    Article  PubMed  Google Scholar 

  8. Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M (2001) Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 15:965–968

    Article  CAS  PubMed  Google Scholar 

  9. Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM (1997) Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 21:629–633

    Article  CAS  PubMed  Google Scholar 

  10. Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH (2006) Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg 30:1698–1704

    Article  PubMed  Google Scholar 

  11. Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211

    Article  PubMed  Google Scholar 

  12. Tang B, Cuschieri A (2006) Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg 10:1081–1091

    Article  PubMed  Google Scholar 

  13. Wiebke EA, Pruitt AL, Howard TJ, Jacobson LE, Broadie TA, Goulet RJ Jr, Canal DF (1996) Conversion of laparoscopic to open cholecystectomy: an analysis of risk factors. Surg Endosc 10:742–745

    CAS  PubMed  Google Scholar 

  14. Moore MJ, Bennett CL (1995) The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 170:55–59

    Article  CAS  PubMed  Google Scholar 

  15. Giger UF, Michel JM, Opitz I, Th Inderbitzin D, Kocher T, Krahenbuhl L (2006) Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22, 953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Coll Surg 203:723–728

    Article  PubMed  Google Scholar 

  16. Kologlu M, Tutuncu T, Yuksek YN, Gozalan U, Daglar G, Kama NA (2004) Using a risk score for conversion from laparoscopic to open cholecystectomy in resident training. Surgery 135:282–287

    Article  PubMed  Google Scholar 

  17. Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M (2001) A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 181:520–525

    Article  CAS  PubMed  Google Scholar 

  18. Lekawa M, Shapiro SJ, Gordon LA, Rothbart J, Hiatt JR (1995) The laparoscopic learning curve. Surg Laparosc Endosc 5:455–458

    CAS  PubMed  Google Scholar 

  19. Riffenburgh RH (2006) Statistics in Medicine, 2nd edn. Elsevier Academic Press, Amsterdam

    Google Scholar 

  20. David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP (2008) Management of acute gallbladder disease in England. Br J Surg 95:472–476

    Article  CAS  PubMed  Google Scholar 

  21. Campbell SE, Campbell MK, Grimshaw JM, Walker AE (2001) A systematic review of discharge coding accuracy. J Public Health Med 23:205–211

    Article  CAS  PubMed  Google Scholar 

  22. Al-Sarira AA, David G, Willmott S, Slavin JP, Deakin M, Corless DJ (2007) Oesophagectomy practice and outcomes in England. Br J Surg 94:585–591

    Article  CAS  PubMed  Google Scholar 

  23. Hobbs MS, Mai Q, Knuiman MW, Fletcher DR, Ridout SC (2006) Surgeon experience and trends in intraoperative complications in laparoscopic cholecystectomy. Br J Surg 93:844–853

    Article  CAS  PubMed  Google Scholar 

  24. NHS Institute for Innovation and Improvement (2006) Focus on Cholecystectomy. www.institute.nhs.uk/option,com_joomcart/Itemid,194/main_page,document_product_info/cPath,71/products_id,186.html

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK

    M. Ballal, G. David, S. Willmott, D. J. Corless & J. P. Slavin

  2. Department of Surgery, University Hospital of North Staffordshire, Stoke-on-Trent , ST4 7PA, UK

    M. Deakin

Authors
  1. M. Ballal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. David
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Willmott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. J. Corless
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Deakin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. P. Slavin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. P. Slavin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ballal, M., David, G., Willmott, S. et al. Conversion after laparoscopic cholecystectomy in England. Surg Endosc 23, 2338–2344 (2009). https://doi.org/10.1007/s00464-009-0338-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0338-1

Keywords

Search

Navigation