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Invited Commentary

David L. Nahrwold, MD
Arch Surg. 1996;131(1):101. doi:10.1001/archsurg.1996.01430130103023.
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The causes of conversion from laparoscopic to open cholecystectomy are worthy of study because patients who undergo conversion are deprived of the advantages of the laparoscopic technique, including shorter hospital stay, earlier return to full activity, less pain, and the absence of a large scar. Surgeons who perform cholecystectomy have witnessed the disappointment of patients and their families when conversion is necessary.

The authors found that conversion was significantly more frequent in patients who were obese, older than 65 years, had a thickened gallbladder wall, or had cholecystectomy as an interval procedure for acute cholecystitis. All of these factors but age could make the identification of important anatomic structures difficult. The need for conversion was also significantly higher for senior surgeons and during the early portion of a surgeon's experience with the procedure. Obviously, inexperience can produce complications. Perhaps the presumably wiser senior surgeons perform conversions more quickly. We hope


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