Assessment of Risk Factors for Conversion in Laparoscopic Cholecystectomy Performed Due to Symptomatic Cholecystolithiasis

INTRODUCTION: Laparoscopic cholecystectomy is the current gold standard in the treatment of symptomatic cholecystolithiasis. The occurrence of the conversion is related to higher perioperative mortality or prolonged hospitalization. The aim of this study was to evaluate selected risk factors for conversion of laparoscopic cholecystectomy among patients undergoing surgery due to symptomatic cholelithiasis. PATIENTS AND METHODS: A retrospective analysis of patients operated on for symptomatic cholelithiasis from November 2021 to June 2023 was performed. Correlations between selected factors and the occurrence of conversion were analyzed. Early outcomes of surgical treatment and the impact of using the Enhanced Recovery After Surgery (ERAS) protocol were analyzed. RESULTS: The analysis concerned 227 patients who were operated on due to symptomatic cholelithiasis. In 28 (12.3%) cases, the procedure was converted to an open method. A multivariate analysis showed that male gender (p=0.003, OR=0.196), type 2 diabetes (p=0.018, OR=4.045), older age (p=0.008, OR=1.063), and a history of acute cholecystitis (p<0.0001, OR=1.981) predispose to conversion. The occurrence of conversion is associated with the increased duration of surgery and hospitalization, a higher rate of surgical site infections, and clinically significant complications (p<0.0001). Statistically significant differences were found in the length of stay depending on the use of the ERAS protocol (p<0.0001). CONCLUSIONS: The most important preoperative risk factors for conversion in the case of cholecystectomy performed due to symptomatic cholelithiasis include male gender, older age, type 2 diabetes, and a history of an episode of acute cholecystitis. The use of the ERAS protocol is safe and does not increase the conversion rate or clinically significant postoperative complications.