Determinants of conversion during laparoscopic cholecystectomy among a sample of Iraqi patients


  • Abutalib B. Alluaibi Department of Surgery, Al-Mawanee General Hospital, Basrah, Iraq
  • Bahaa K. Hassan Department of Surgery, Al-Mawanee General Hospital, Basrah, Iraq
  • Alaa H. Ali Department of Surgery, Al-Mawanee General Hospital, Basrah, Iraq
  • Ahmed A. Muhsen Department of Surgery, Al-Mawanee General Hospital, Basrah, Iraq



Conversion, Determinants, Iraq, Laparoscopic cholecystectomy, Open


Background: Laparoscopic cholecystectomy has become a standard technique for gall bladder surgery of symptomatic cholelithiasis. However, conversion to open cholecystectomy is sometimes necessary. The aim of the present study was to assess the predictive factors that increase the possibility of conversion of laparoscopic cholecystectomy to open cholecystectomy.

Methods: A total of 621 laparoscopic cholecystectomies were attempted at AL-Mawanee General Hospital and AL-Sader Teaching Hospital in Basrah, IRAQ from June 2012 till June 2016.Of these,43 had to be converted to open cholecystectomies. Patients assessed according to different factors, including age, sex, acute cholecystitis, adhesions of gallbladder and calot's triangle, obesity, previous abdominal surgery, anatomical variation of gallbladder and Calot's triangle and intraoperative complications (bleeding, bile duct injury, visceral injury).

Results: Conversion to open cholecystectomy was performed in 43 patients (6.92%). The significant factors for conversions were adhesions of gallbladder and Calot's triangle(39.53%) followed by acute cholecystitis(34.88%). Rate of conversion in other factors are as the following i.e., isolated male gender (0%), age (0%), previous abdominal surgery (9.3%), obesity (2.33%), anatomical variations of gall bladder and calot's triangle (2.33%), intra operative complications including bleeding (4.65%), bile duct injury (4.65%), visceral injury (2.33%) were insignificant factors for conversion.

Conclusions: Adhesions of gallbladder and calot's triangle is the most common predictive factor and cause for conversion from laparoscopic cholecystectomy to open cholecystectomy. Acute cholecystitis found to be the strongest factor for conversion despite its incidence is lower than adhesions of gall bladder and calots triangle. Male gender and age more than fifty years are not direct predictive factors for conversions.


Freiherr G. Gallstone. Statistical consideration. Year Book Medical Publishers, 1989;4:139-40.

Mouret P. Celioscopic surgery. Evolution or Revolution. Cirurgie, 1990;116: 829-32.

Bateson M. Second opinion in laparoscopic cholecystectomy. Lancet. 1994;344(8915):76.

Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surgery. 2002;184(3):254-8.

Fullarton GM, Bell G. Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group. Gut. 1994;35(8):1121-6.

George M, Janet SM. Incidence of conversion in laparoscopic surgery. Med J Nor. 2010;23:124-31.

Poston GJ, Blumgart LH. Surgical management of hepato-biliary and pancreatic disorders. Taylor and Francis. 2005;18:475-92.

Freid GM, Barkun JS, Sigmen HH, Joseph L, Clas D, Garzon J, et al.Factors determining conversion to laparotomy in patients undergo laparoscopic cholecystectomy. Am J Surg. 1994;167(1):39-41.

Verma S, Agarwal PN, Bali RS, Singh R, Talwar N. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: A Prospective Randomized Trial. Min Inv Surg. 2013;3:13-18.

Kapuran KL, Slorene MF. Conversion from laparoscopic cholecystectomy to open cholecystectomy. Germ J Surg. 2009;23:13-20.

Yetkin G, Uludag M, Citgez B, Akgun I, Karakoc S. Predictive Factors for conversion of laparoscopic cholecystectomy in patients with acute cholecystitis. Bratist Lek Listy, 2009;10(11): 688-91.

Gilbert MZ, Maria J. Conversion rates of laparoscopic to open cholecystectomy: statistical analysis of 1200 cases. World Stat J, 2011;32:8-12.

Bennion LJ, Grundy SM. Risk factors for the development of cholelithiasis in man. New Eng J Med. 1978;299(21):1161-7.

Nakeeb A, Comuzzie AG, Martin L, Sonnenberg GE, Swartz-Basile D, Kissebah AH, et al. Gall stones: Genetic versus Environment. Ann Surg, 2002;235(6):842-9.

Lein HH, Huang CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg. 2002;26(5):598-601.

Zisman A, Gold-Deutch R, Zisman E, Negri M, Halpern Z, Lin G, Halevy A. Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?. Surg Endosc. 1996;10(9):892-4.

Bazoua G, Tilston MP. Male gender impact on the outcome of laparoscopic cholecystectomy. JSLS: J Soc Laparoendosco Surgeon. 2014;18(1):50-4.

Costantini R, Caldalaro F, Palmieri C, Napolitano L, Aceto L, Cellini C. Risk factors of conversion of laparoscopic cholecystectomy. Ann Italy Chir. 2012;83245-52.

Yol S, Khartal A, Vatansev C, Aksoy F, Toy H. Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery. J Soc Laparoscopic Surgon. 2006;10(3):359-363.

Hutchinson CH, Traverso LW, Lee FT. Laparoscopic cholecystectomy, do pre-operative factors predict the need to convert to open? Surg Endosc. 1994:8(8);875-78.

Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors influencing the successful completion of laparoscopic cholecystectomy. J Soc Laparoendosco Surgeon. 2009;13(4):581.

Wiebke EA, Pruitt AL, Howard TJ, Jacobson LE, Broadie TA, Goulet RJ, et al. Conversion of laparoscopic to open cholecystectomy. Surg Endoscop. 1996;10(7):742-5.

Bhar P, Halder KS, Ray RP, Bhattacharjee PK. Preoperative prediction of difficult laparoscopic cholecystectomy. Indian Medical Gazette. 2013;128-33.

Livingston EH, Rege RV. A Nationwide study of conversion from laparoscopic to open Cholecystectomy. Am J Surg, 2004;188(3):205-11.

Sikora SS, Kumar A, Saxena R, Kapoor VK, Kaushik SP. Laparoscopic cholecystectomy- can conversion be predicted?. World J Surg. 1995;19(6):858-60.

Kohli R, Bansal E, Gupta AK, Matreja PS. A study of laparoscopic cholecystectomy in patients with previous abdominal surgery. Med Res Chron. 2014; 1(2):130-40.

Jain V, Attri PC, Kumar D, Chaudary N. Evaluation of feasibility of laparoscopic cholecystectomy in patients with previous history of (either upper or lower) abdominal surgery. Int J Med Sci Clin Invent. 2015;2(1):672-80.

Lee CO, Mao H, Christopher K.S. Conversion to open cholecystectomy in patients with acute cholecystitis. Thai Endo J. 2009;3:132-7.

Chandler CF, Lane JS, Ferguson P. Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg, 2000;66: 896-900.

Cox MR, Wilson TG, Luck AJ, Jeans PL. Laparoscopic cholecystectomy for acute inflammation of the gall bladder. Ann Surg. 1993;218:630-4.

Jaffer SA, Alfadagh Z, Mohammed MA. Early versus delayed laparoscopic cholecystectomy in acute cholecystitis. Bas J Surg. 2013;19:30-3.

Memon MR, Muhammad G, Arshad S, Jat MA, Bozdar AG, Shah SQA. Study of open conversion in laparoscopic Cholecystectomy. Gomal Journal of Med Sci. 2011;9(1):51-4.

Biswas SK, Saha JC, Rahman AS, Rahman AS, Rahman MM. Rate of conversion and postoperative complications of laparoscopic cholecystectomy in district level hospital of Bangladesh. Faridpur Med Coll J. 2011;6(2):74-7.

Gejje S, Hongal A, Srimurthy KR, Ravishankar HR, Khuller S. Aprospective study of the laparoscopic anatomy of calot's triangle, variations and its surgical implications. Int J Biol Med Res. 2014;5(4):4632-40.

Dholia KM, Memon AA, Shaikh MS, Shaikh SA. Laparoscopic Cholecystectomy: Experience of 100 cases at a teaching hospital of Sindh. J Liaquat Univ Med Health Sci. 2005;4(3):105-8.

Lim SH, Salleh I, Poh BK, Tay KH. Laparoscopic cholecystectomy: an audit of our training programme. ANZ J Surg. 2005;75(4):231-3.

Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg. 1995;130(10):1123-8.

Hashizume M, Sugimachi K. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endoscop. 1997;11(12):1198-201.






Original Research Articles