An Observational Study to Determine the Factors Predisposing to the Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic gallstone disease. However, conversion to open cholecystectomy (OC) remains necessary in a subset of patients due to difficult anatomy, inflammation, or intraoperative complications. Identification of preoperative predictors can improve operative planning and patient counseling.
Aim: To identify clinical, biochemical, and ultrasonographic factors associated with conversion of laparoscopic cholecystectomy to open cholecystectomy.
Methods: A hospital-based cross-sectional observational study was conducted in the Department of General Surgery, VIMSAR, Burla, from April 2021 to October 2022. A total of 256 patients undergoing elective laparoscopic cholecystectomy were included. Demographic characteristics, laboratory parameters, ultrasonographic findings, and operative outcomes were analyzed using SPSS software.
Results: Among 256 patients, 44 (17.2%) required conversion to open cholecystectomy. Male gender (p<0.001), BMI >30 kg/m² (p<0.001), recurrent attacks of cholecystitis (p=0.001), elevated serum amylase (p=0.018), contracted gallbladder (p=0.013), gallbladder wall thickness >3 mm (p=0.002), and previous abdominal surgery (p<0.001) were significantly associated with conversion. Age, serum bilirubin, serum alkaline phosphatase, and pericholecystic collection were not significant predictors.
Conclusion: Readily available preoperative clinical and radiological factors can reliably predict difficult laparoscopic cholecystectomy and the likelihood of conversion to open surgery.