Predictors and Risk Factors for Laparoscopic to Open Cholecystectomy Conversion: A Preoperative and Intraoperative Analysis

Abstract

Background and objectives: The choice to convert a laparoscopic to open cholecystectomy is heavily influenced by factors that occur before and during operation. Preoperative issues that might impact the viability of a laparoscopic procedure include obesity, previous abdominal operations, and acute cholecystitis in patients. The Aim of this study is to identify and determine preoperative and intraoperative predictive factors associated with the conversation of laparoscopic cholecystectomy to open surgery. Methods: Over the period of Jan.2023 – Jan.2024, a prospective study was conducted in Shar and Teaching Sulaymaniyah hospitals, Iraq. Using a database of 275 patients in whom laparoscopic cholecystectomy procedure was attempted. Result: The analysis revealed that 146 (53.1%) of cases were over 41 years old, with females constituting the majority 226 (82.2%). Nearly half of the patients 134 (48.7%) had a normal body mass index, while 41.1% were overweight, and 10.2% were obese. Stones were absent in 8.4% of cases, and polyps in 9.1%, with 25.1% of patients having prior abdominal surgery. Overall, the findings highlight successful surgical outcomes with minimal complications. Male gender, prior abdominal surgery, acute cholecystitis, and thicker gallbladder wall on preoperative ultrasonography were significantly independent prognostic factors for conversion. Conclusion: The analysis highlights that the conversion rate is slightly higher in males compared to females, and in patients over 41 years old compared to those aged 13–40. Most surgeries did not involve conversion, reflecting minimal unexpected complications or findings. The data suggest that surgical procedures were generally successful with low conversion rates.