Published: 2019-06-29

Is early conversion of laparoscopic to open cholecystectomy helpful in preventing iatrogenic injuries: a retrospective study from a single unit of a tertiary care centre

Dheer S. Kalwaniya, Jaspreet S. Bajwa, S. V. Arya, Rajkumar C., Ashok K. Sharma, Nikita Wadhwani, Vignesh M., Rohit C.


Background: Gall stone disease is the commonest hepatobiliary problem which is tackled by either laparoscopic or open technique. Since the advent of laparoscopic cholecystectomy by Eric Muhne in 1985, it has become gold standard for gall bladder removal. But a surgeon must be competent enough to convert it into open procedure, provided there are on table complications. Moreover, since laparoscopic surgery has a learning curve, open procedure for any surgery is must for safety of the patient as well as the surgeon.

Methods: A retrospective study is done over a period of 4 years (January, 2015 to December, 2018) and data of 469 patients undergoing laparoscopic cholecystectomy in a single unit of Safdarjung Hospital, New Delhi, India has been collected and evaluated for conversion to open procedure on the basis of intraoperative findings. The complications noted and the intraoperative findings and the reasons of conversion to open cholecystectomy have been compared to the previous studies done.

Results: Out of total 469 cases, M:F ratio was 1:3.51. Total 40 underwent conversion to open cholecystectomy (8.54%) with M:F ratio of 1:2.07. Most common cause of conversion was dense adhesions in Calot’s triangle along with omentum and bowel. Single patient had agenesis of gall bladder. There was no iatrogenic injury to common bile duct, common hepatic duct and there were no postoperative mortalities.

Conclusions: Early conversion to open cholecystectomy is associated with lower intraoperative iatrogenic injuries and hence, lowers postoperative morbidity.


Laparoscopic cholecystectomy, Open cholecystectomy, Calot’s triangle

Full Text:



Muhammad A, Shafqat R. Rate and reason of conversion of laparoscopic to open cholecystectomy. A prospective analysis of 450 consecutive laparoscopic cholecystectomies. Pak Armed Forces Med J. 2016;66(1):117-21.

Soper NJ, Stockmann PT, Dunnegan DL. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991;213.665.

Waseem M, Tariq WK, Abdul S. Laparoscopic cholecystectomy: conversion rates and its causes at ISRA university hospital, Hyderabad. Rawal Med J. 2008;33(2):1-7.

Mirza MA, Wasty WH, Habib L. An audit of cholecystectomy. Pak J Surg. 2007;23:104-8.

Dohlia KM, Memon AA, Sheikh MS. Laparoscopic cholecystectomy: experience of 100 cases at teaching hospital, Sindh. J Liaqat Univmed Health Sci. 2005;4:105-8.

Guraya SY, Khairy GEA, Murshid KR. Audit of laparoscopic cholecystectomy: 5 year experience in a university hospital. Ann King Edward Med Coll. 2004;10:9-10.

Vecchio R, Macfadyen BV, Laterri S. Laparpscopic cholecystectomy: analysis of 114005 cases of united states series. Int Surg. 1998;83:215-9.

Tarcovenau E, Nicculescu D, Geprgescu S. Conversion in laparoscopic cholecystectomy. Chirurgia. 2005;100:437-44.

Cruscheri A, Dubois. F, Maniel J. The european experience with laparoscopic cholecystectomy. Annals Surg. 1991;161:385-7.

Kama NA, Kologlu M, Doganay M. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg. 1995;169:9-19.

Butt AU, Sadiq I. Conversion of laparoscopic to open cholechstectomy – six year experience at Shalamar hospital, Lahore. Ann King Edward Med Coll. 2006;12:536-8.

Lim KR, Ibrahim S, Tan NC. Risk factors for conversion to open surgery in patients with acute cholecystitis undergoing interval laparoscopic cholecystectomy. Ann Acad Med Singapore. 2007;36(8):631-5.

Hasaniah WF, Sayed MA, Sayer H. Is laparoscopic cholecystectomy a safe procedure for patients recieving anticoagulants. Med Principles Pract. 2002;11:105-7.

Larson GM, Voyles CR. Multipractice analysis of laparoscopic cholecystectomy in 1983 patients. Am J Surg. 1992;163(2);221-6.

Croce E, Azzola M, Golia M. Lapcholecystectomy 6865 cases from Italian institutions. Surg Endosc. 1994;9:1088-91.

Newman CL, Wilson RA, Newman L. 1525 laparoscopic cholecystectomies without a biliary injury. A single institution experience. Am Surg. 1995;61:226-8.

Magee TR, Galland RB, Dehn TC. A prospective audit of cholecystectomy in a single health district. J Royal Coll Surg, Edinberg. 1996;41(6):388-90.

Bakos E, Bakos M, Dubaz M. Conversion in laparoacopic cholecystectomy. Brasil Lek Listy. 2008;109(7):317-9.