Published: 2022-01-29

Risk factors and surgical outcomes of conversion of minimally invasive surgery to open procedure

Raghavendra Y. Srinivas, Komal Gupta, Yashvant Singh Rathore, Sunil Chumber, Khaja Abdul Moin Baig, Prasanna Ramana


Background: Majority of laparoscopic procedures can be performed on day-care surgery basis, unexpected conversion to open surgery requires overnight or longer admission in these patients and can have additional financial and psychological impact on the patient. The aim of our study is to study the risk factors associated with conversion and the surgical outcomes in patients who underwent conversion of minimally invasive surgery to open procedure.

Methods: It was a prospective observational study. All the patients who were planned for minimally invasive surgery but had intraoperative conversion to open surgeries were included.

Results: A total of 41 patients were recruited in the study. Mean age of the patients was 44.7 years. Male patients had more frequent conversion (24 patients, 58.5%). 11 patients (26.8%) had history of previous surgery. Most common cause of conversion to open procedure was dense intra operative adhesions (24 patients, 58.5%); followed by iatrogenic injury to surrounding visceral organs or uncontrolled bleeding (11 patients, 26.8%). The average recovery time (duration till return to work) was 12 days. As per Clavien-Dindo classification, 28 patients (68.29%) had grade I, 9 patients (21.95%) had grade II, 3 (7.31%) had grade III, and one patient (2.43%) had grade IV complication.

Conclusions: History of previous surgery and presence of intraoperative adhesions were frequently present in patients who underwent conversion of minimally invasive procedure. These patients required long period for recovery from the surgery and had frequent minor surgical complications.


Laparoscopy, Conversion to open, Laparotomy, Hepatobiliary surgery, Laparoscopic cholecystectomy

Full Text:



Wolf AS, Nijsse BA, Sokal SM, Chang Y, Berger DL. Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg. 2009;197(6):781-4.

Johansson M, Thune A, Nelvin L, Lundell L. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg. 2006;93(1):40-5.

Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015;18:196-204.

Buentzel J, Straube C, Heinz J, Roever C, Beham A, Emmert A et al. Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made? Medicine (Baltimore). 2017;96(24):e7161.

Athanasiou C, Lockwood S, Markides GA. Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature. World J Surg. 2017;41(12):3083-99.

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(5):920-30.

Sanabria JR, Gallinger S, Croxford R, Strasberg SM. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg. 1994;179(6):696-704.

Ashfaq A, Ahmadieh K, Shah AA, Chapital AB, Harold KL, Johnson DJ. The difficult gall bladder: Outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg. 2016;212(6):1261-4.

Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg. 2012;256(1):39-52.

Petrucciani N, Memeo R, Genova P, Le Roy B, Courtot L, Voron T et al. Impact of Conversion from Laparoscopy to Open Surgery in Patients with Right Colon Cancer. Am Surg. 2019;85(2):177-82.

Lian B, Chen J, Li Z, Ji G, Wang S, Zhao Q et al. Risk Factors and Clavien-Dindo Classification of Postoperative Complications After Laparoscopic and Open Gastrectomies for Gastric Cancer: A Single-Center, Large Sample, Retrospective Cohort Study. Cancer Manag Res. 2020;12:12029-39.

Ebbing J, Wiebach T, Kempkensteffen C, Miller K, Bachmann A, G├╝nzel K et al. Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien-Dindo classification. Eur J Surg Oncol. 2015;41(7):941-52.

Tamagawa H, Aoyama T, Numata M, Kazama K, Maezawa Y, Atsumi Y et al. A Comparison of Open and Laparoscopic-assisted Colectomy for Obstructive Colon Cancer. In Vivo. 2020;34(5):2797-801.