[Acute and chronic cholecystopathies: analysis comparative of the rates and causes of conversion to laparotomy].

OBJECTIVES

To analyze the rate and main causes for conversion to open surgery among acute and chronic cholecystitis.

METHODS

A retrospective analysis of 1359 patient medical charts submitted to cholecystectomy in hospitalUniversitário Cajuru's general surgery department was done during the period from january 2000 to october 2006.

RESULTS

One thousand and sixty six laparoscopic cholecystectomies were performed, 701 (65.75%) due to chronic cholecystolithiasis, 356 (33.39%) due to acute cholecystolithiasis, seven (0.65%) had gallbladder polyps and two (0.21%) cases had hydropic gallbladder. The conversion rate in acute cases was 7.86%, and in chronic cases were 2.85% (p=0.0003). The average age for conversion was 50.96 +/- 17.49 years-old for acute cases and 56.45 +/- 12.28 years-old for chronic cases. The operative meantime was 152.5 minutes (30 - 36) for acute and 157.5 minutes (90 - 240) for chronic cholecystolithiasis (p=0.959). The conversion reasons for chronic cholecystolithiasis were: obscure anatomy in 16 cases (80%) and adhesions in 14 cases (70%), considering that in ten cases both causes were associated. For acute presentation, conversions were due to adhesions in 13 (46.42%) patients and technical difficulties were found in 8 (28.57%) patients (p=0.008).

CONCLUSION

The rate for conversion of laparoscopic cholecystectomy to open surgery is higher in acute cholecystolithiasis when in comparison to chronic ones. Both, the presence of adhesions in acute cases, and difficult anatomy identification in chronic cases, were the most common reasons to impair the laparoscopic procedures performance in our department.