Conversion to open surgery in the era of laparoscopic cholecystectomy: Changing rates and reasons in geriatric patients

Objective: Compared to open surgery; laparoscopic cholecystectomy has become the standard of care for the treatment of cholelithiasis at any age over the last two decades. In the present study, the aim was to identify and to compare the rates and reasons involved in conversion to open procedure in elective surgery for cholelithiasis in geriatric patients over the course of fourteen years. Methods: To assess the possible differences in the conversion rates and reasons over time, 207 patients over 65 years of age undergoing elective laparoscopic cholecystectomy for chronic cholecystitis were analyzed in two groups - the first ten years (n=141) and the last four years (n=66). Acute cholecystitis, gallbladder malignancy and/or polyps were excluded. Demographic characteristics, comorbidities, history of previous abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography (ERCP) and the reasons and rates involved in conversion to open cholecystectomy were all analyzed. Results: In male and female patients, the conversion rate was 18.8% and 5.07 %, respectively (p=0.02). In the first ten years, the conversion rate was 11.3%, while in last four years, it was 6.1% (p=0.230). In first ten years, 62.5% of the reason for conversion was found to be dense pericholecystic adhesions related, but in last four years, this rate decreased notably to 25%. Conclusions: Although there was no statistical significance, in last four years, surgeons seemed to more easily overcome difficult cholecystectomies.