Conversion rate and the probable factors for conversion from laparoscopic to open cholecystectomy


  • Balen Salahaddin Muhammed Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Azhy Muhammed Dewana Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Baderkhan Saeed Ahmed Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.



Laparoscopic cholecystectomy, Gall bladder, Conversion to open


Background and objective: In western countries, the incidence of Cholelithiasis is found to be more than 10% in general populations. After performing the first successful laparoscopic cholecystectomy (L.C.) in Germany by Muhe in 1986, it rapidly became the procedure of choice in treating symptomatic gall stone. L.C. has a lot of advantages, including minimal trauma, rapid recovery, less analgesic requirement with a good esthetic outcome, however even in the hands of a best surgeon still there is a small percentage of conversion to open laparotomy, some risk factors has been recognized as a reason for the conversion to open laparotomy. This study aims to evaluate the rate with the underlying risk factors that increase the chance of conversion to open cholecystectomy.

Methods: A total of 1400 patients for whom L.C. was attempted, 54 were enrolled in this prospective study from January 2014 to January 2020. The exclusion criteria were malignancy or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rates of conversion to open cholecystectomy with the underlying reasons for conversion were analyzed.

Results: The overall rate of conversion to open cholecystectomy was 3.86% (54 patients). Out of 54 cases nearly two-thirds (61.1%) of the patients (33) were males and 38.9% of the patients (21) were females. Male: female ratio is 1.57:1. In the study sample, the conversion rate among obese (14/54) patients was 25.9% compared with the rate of 74.1% among non-obese (40/54) patients. Out of 3.86% of the conversion rate, 2.86% were non-obese and 1% were obese patients. The commonest etiology for conversion was thickened gall bladder due to severe gall bladder inflammation with fibrosis (21 patients) 38.9% followed by Acute cholecystitis (8 patients) 14.8%, then fibrosis (7 patients) 13% with aberrant anatomy at the calots triangle (6 patients) 11.1%.

Conclusion: A thickened gall bladder was found to be the commonest risk factor for conversion to open cholecystectomy, the conversion from L.C. to O.C. should not be regarded as a failure of the procedure or as a complication, rather it should be regarded as a prudent maneuver for achieving the desired objective namely safe removal of the gall bladder.


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Nidoni R, Udachan TV, Sasnur P, Baloorkar R, Sindgikar V, Narasangi B. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. JCDR. 2015; 9(12):9–12. doi: 10.7860/JCDR/2015/15593. 6929. Epub 2015 Dec 1.

Teitelbaum EN, Soper NJ. Cholelithiasis and Cholecystitis. In: Zinner MJ, Ashley SW, Hines OJ. Maingot’s Abdominal Operations. 13th ed. USA: The McGraw-Hill Education; 2019.

Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, et al. Laparoscopic cholecystectomy: Consensus conference-based guidelines. Langenbecks Arch Surg. 2015; 400(4):429–53.

Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA. Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg. 2011; 201:789–96. DOI: 10.1016/j.amjsurg.2010.04.018

Kala S, Verma S, Dutta G. Difficult situations in laparoscopic cholecystectomy: a multicentric retrospective study. Surg Laparosc Endosc Percutan Tech. 2014; 24:484-7. doi: 10.1097/SLE.0b013e31829cebd8.

Volkan G, Sulaimanov M, Cipe G, Basceken SI, Erverdi N, Gurel M, et al. What necessitates the conversion to open cholecystectomy? Aretrospective analysis of 5164 consecutive laparoscopic operations. Clinics (Sao Paulo). 2011; 66:417-20. DOI:10.1590/S1807-59322011000300009

Santos BF, Brunt LM, Pucci MJ. The difficult gallbladder: a safe approach to a dangerous problem. J Laparoendosc Adv Surg Tech A. 2017; 27:571–8. doi: 10.1089/lap.2017. 0038. Epub 2017 Mar 28.

Sugrue M, Coccolini F, Bucholc M, Johnston A. Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study. World J Emerg Surg. 2019; 14:12. doi: 10.1186/s13017-019-0230-9.

Abelson JS, Afaneh C, Rich BS, Dakin G, Zarnegar R, Fahey TJ, et al. Advanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: a retrospective cohort study. Int J Surg. 2015; 13:221–6. doi: 10.1016/j.ijsu.2014.12.016.

Tazuma S,Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M, et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol 2017; 52:276–300. doi: 10.1007/s00535-016-1289-7. Epub 2016 Dec 10.

Albrecht R, Franke K, Koch H, Saeger HD. Prospektive Evaluation von Risikofaktoren bezüglich intraoperativer Konversion von laparoskopischer zu offener Cholezystektomie [Prospective Evaluation of Risk Factors Concerning Intraoperative Conversion from Laparoscopic to Open Cholecystectomy]. Zentralbl Chir. 2016; 141: 204–9. DOI: 10.1055/s-0032-1328348

Thesbjerg SE, Harboe KM, Bardram L, Rosenberg J. Sex differences in laparoscopic cholecystectomy. Surg Endosc. 2010; 24:3068–72. DOI: 10.1007/s00464-010-1091-1

O’Leary DP, Myers E, Waldron D, Coffey JC. Beware the contracted gallbladder Ultrasonic predictors of conversion. Surgeon. 2013; 11:187–90. DOI: 10.1016/j.surge.2012.11.001

Agarwal N, Singh S, Khichy S. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method. Niger J Surg. 2015; 21(2):130–3. Doi: 10.4103/1117-6806.162567

Gupta N, Ranjan G, Arora MP, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013; 11(9):1002–6. DOI: 10.1016/j.ijsu.2013.05.037

Bhondave ST, Dash N, Thipse VJ, Gadekar JM.Proposed Diagnostic Scoring System to Predict Difficult Laparoscopic Cholecystectomy. JMSCR. 2017; 5 (12):31682–8. DOI:

Coelho JCU, Dalledone GO, Schiel W, Berbardin JP, Claus CMP, Marias JEF, et al. Does male gender increase the risk of laparoscopic cholecystectomy? ABCD Arq Bras Cir Dig. 2019; 32(2):e1438. DOI: /10.1590/0102-672020190001e1438

Lee NW, Collins J, Britt LD. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. Am J Surg. 2012; 78(8):831–3. Doi: 10.1007/s00464-001-0008-4. Epub2012.

Hussain A. Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparosc Percutan Tech. 2011; 21(4):211–7. Doi: 10.1097/SLE.0b013e318220f1b1

Dominguez LC, Rivera A, Bermudez C, Herrera W. Analysis of factors for conversion of laparoscopic to open cholecystectomy: A prospective study of 703 patients with acute cholecystitis. Cir Esp. 2011; 89:300–6. Doi: 10. 1016/j.ciresp.2011.01.009. Epub 2011 Mar 12.

Wevers KP, van Westreenen HL, Patijn GA. Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion. Surg Laparosc Endosc Percutan Tech. 2013; 23:163–6. DOI: 10.1097/SLE.0b013e31826d7fb0

Sippey M, Grzybowski M, Manwaring ML, Kasten KR, Chapman WH, Pofahl WE, et al. Acute cholecystitis:risk factors for conversion to an open procedure. J Surg Res. 2015; 199:357–61.

Teckchandani N, Garg PK, Hadke NS, Jain SK, Kant R, Mandal AK, et al. Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: A prospective study. Int J Surg. 2010; 8:623–7. DOI: 10.1016/j.ijsu.2010.05.014

Hu ASY, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery- A systematic literature review of 30 studies. Am J Surg. 2017; 214:920–30. DOI: 10.1016/j.amjsurg.2017.07.029

Lowndes B, Thiels CA, Habermann EB, Bingener J, Hallbeck S, Yu D. Impact of patient factors on operative duration during laparoscopic cholecystectomy: evaluation from the National Surgical Quality Improvement Program database. Am J Surg. 2016; 212:289–96. DOI: 10.1016/j.amjsurg.2016.01.024

Nidoni R, Vudachan T, Sasnur P, Baloorkar R, Sindgikar ,Narasangi B.Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment. J Clin of Diagn Res. 2015; 9(12):PC09–12. Doi: 10.7860/JCDR/ 2015/15593.6929

Ghnman W, Malek J, Shebl E, Elbeshry T, Ibrahim A. Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2010; 30:145–8. Doi: 10.4103/0256- 4947.60521

Ercan M, Bostanci EB, Teke Z, Karaman K, Dalgic T, Ulas M, et al. Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2010; 20:427–34, Doi: 10.1089/lap.2009.0457




How to Cite

Muhammed, B. S., Muhammed Dewana, A. ., & Saeed Ahmed, B. . (2023). Conversion rate and the probable factors for conversion from laparoscopic to open cholecystectomy. Zanco Journal of Medical Sciences (Zanco J Med Sci), 27(2), 136–144.



Original Articles