“AEIOU: the ABC's” of Conversion from Laparoscopic to Open Cholecystectomy

BACKGROUND AND OBJECTIVES: To examine and classify the reasons for conversion and the points at which laparoscopic cholecystectomies are converted to open procedures and whether these change over time. METHODS: This is a retrospective study of all patients undergoing cholecystectomy from June 1, 1990 to June 30, 1995. Reasons for conversion were classified using the “AEIOU:ABC” system developed for this study and conversion points were assigned chronologically. RESULTS: The “AEIOU:ABC” classification system was utilized. The most common reasons for conversion were: acute inflammation N=61 (26.1%); adhesions N=51 (21.8%); and organ system pathology N=39 (16.7%). The most common conversion points were; after visualization of the peritoneal cavity but prior to dissection of the cystic structures N=103 (44.0%); dissection of the cystic structures N=58 (24.8%); initial laparoscopy N=36 (15.4%). When the reasons for conversion were evaluated for changes over time there was no statistically significant change for the total group or any individual surgeon. Conversion points did not change with increasing operative experience. CONCLUSION: The “AEIOU:ABC” classification system is a simple, effective and easy to use system for classifying the myriad of reasons for conversion. The system needs to be validated prospectively not only for laparoscopic cholecystectomy but for possible application to other laparoscopic procedures.