Risk Factors of Open Converted Cholecystectomy for Cholelithiasis After Endoscopic Removal of Choledocholithiasis

Background: Open converted cholecystectomy could occur in patients who planned for laparoscopic cholecystectomy after endoscopic removal of choledocholithiasis.

Aim: To evaluate the risk factors associated with open converted cholecystectomy.

Patients and Methods: The data for all patients who underwent cholecystectomy after endoscopic removal of choledocholithiasis were retrospectively reviewed. Factors predictive for conversion to open cholecystectomy were analyzed.

Results: The rate of open converted cholecystectomy was 15.7 %. In multivariate analysis, cholecystitis (OR 1.908, 95 % CI 1.390–6.388, p = 0.005), mechanical lithotripsy (OR 6.129, 95 % CI 1.867–20.123, p < 0.005), and two or more choledocholithiases (OR 2.202, 95 % CI 1.097–4.420, p = 0.026) revealed significant risk factors for conversion to open cholecystectomy. Analyzing the risk factors for open converted cholecystectomy according to duration from endoscopic stone removal to cholecystectomy (within 2 weeks, between 2 and 6 weeks, and beyond 6 weeks), acute cholangitis (OR 3.374, 95 % CI 1.267–8.988, p = 0.015), cholecystitis (OR 3.127, 95 % CI 1.100–8.894, p = 0.033), and mechanical lithotripsy (OR 17.504, 95 % CI 3.548–86.355, p < 0.005) were related to open converted cholecystectomy in ≤2 weeks group.

Conclusions: For patients who need cholecystectomy after endoscopic removal of choledocholithiasis, endoscopic retrograde cholangiography-related factors predictive for open converted cholecystectomy are helpful in planning the appropriate timing of surgery.