Laparoscopic cholecystectomy for acute cholecystitis performed by residents in surgery: a risk factor for conversion to open laparotomy?

Recent observations point to a seemingly high conversion rate to laparotomy in cases of laparoscopic operations for acute cholecystitis that are performed by surgical residents. The purpose of the study is to evaluate those observations. In a retrospective nonrandomized study, conducted between February 1992 and December 1997, 285 laparoscopic operations for acute cholecystitis were analyzed. Those performed by attending surgeons were compared with those performed by residents assisted by attending surgeons. Of 123 laparoscopic operations performed by laparoscopic surgeons between February 1992 and September 1995, 20.3% were converted to laparotomy, compared with 41.3% of the 29 operations performed by the residents (p < 0.017), with no increase in complication rate. Factors like male sex, duration of upper abdominal pain, and severity of the inflammatory process were not significantly different in both groups. The residents' seniority did not influence the conversion rate. A constant and significant decrease in conversion rate to laparotomy was observed over the course of time, as the study proceeded to December 31, 1997 (p < 0.01). We conclude that the performance of difficult laparoscopic cholecystectomy by residents with the assistance of attending surgeons is feasible, but carries a higher conversion rate to laparotomy for reasons that are not entirely clear. The possibility of a learning curve of the residents is suggested.