Factors affecting the risk of conversion from laparoscopy to open surgery in xanthogranulomatous cholecystitis: a retrospective cohort study

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BACKGROUND: Xanthogranulomatous cholecystitis is a rare benign pathology that can mimic gallbladder cancer. Due to inflammation-related adhesions in the gallbladder, cholecystectomy can be particularly challenging in these patients, and the conversion rates from laparoscopy to open surgery are significantly higher than normal. This study aimed to evaluate the factors influencing conversion rates in cases of xanthogranulomatous cholecystitis. METHODS: Patients who underwent cholecystectomy and were pathologically diagnosed with xanthogranulomatous cholecystitis between 2018 and 2024 were included in the study. Patients were categorized into two groups: those who underwent laparoscopic cholecystectomy and those requiring conversion to open surgery. Demographic, clinical, biochemical, and radiological data were analyzed. RESULTS: A total of 46 patients were evaluated. The median age was 56 years (range: 29-80), and 23 patients (50%) were female. Conversion to open surgery was required in 18 patients (39.2%). In univariate analysis, a history of prior ERCP (p = 0.004), increased gallbladder wall thickness (p = 0.004), and an enlarged common bile duct diameter (p = 0.032) were associated with a higher risk of conversion. Multivariate analysis identified prior ERCP (Odds Ratio [OR]: 24.48, 95% Confidence Interval [95%-CI]: 2.25-265.95, p = 0.009) and increased gallbladder wall thickness (OR: 5.94, 95%-CI: 1.31-26.89, p = 0.021) as independent risk factors for conversion. CONCLUSION: The conversion rate from laparoscopy to open surgery is considerably high in cases of xanthogranulomatous cholecystitis compared to other etiologies. The risk is even greater in patients with a history of ERCP and increased gallbladder wall thickness.

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