Gallstones stand as one of the most prevalent gastrointestinal conditions necessitating hospitalization. These stones are found in 10-25% of the general population, with the majority of cases remaining asymptomatic. Notably, obesity has emerged as a significant risk factor for the development of symptomatic cholelithiasis. In this context, abdominal ultrasound proves to be an exceedingly valuable and precise diagnostic tool for detecting the presence of gallstones [3].

The performance of a laparoscopic cholecystectomy necessitates general anesthesia along with muscle relaxation. The primary contraindication for undergoing a laparoscopic cholecystectomy is the patient’s inability to tolerate general anesthesia. The initial and crucial step towards a successful laparoscopic cholecystectomy is assembling a proficient operating team. This team should comprise a highly trained laparoscopic surgeon, a first assistant possessing equivalent skills, and a camera operator who is well-versed in the anatomy and techniques specific to laparoscopic cholecystectomy. Prior to undergoing laparoscopic cholecystectomy, it is essential that all patients receive preoperative information. Additionally, a thorough assessment of preoperative risk factors should be conducted to estimate the likelihood of conversion from laparoscopic to open cholecystectomy [4].

It’s important to note that the conversion of a laparoscopic procedure to an open surgery should not be considered a complication; rather, it should be viewed as a proactive measure aimed at preventing complications.Identifying these risk factors before the procedure can indeed help prevent potential conversions to open cholecystectomy, offering significant benefits to both the surgeon and the patient. This proactive approach enhances the overall safety and success of the surgical intervention. The objective of this study was to assess the factors linked to the conversion of laparoscopic cholecystectomy to open cholecystectomy.

The main goal of this study was to identify the factors that lead to the conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center.

This prospective observational study encompassed 200 patients admitted due to symptomatic gallbladder disease and scheduled to undergo laparoscopic cholecystectomy. Ethical clearance approval was obtained, and informed consent was acquired from each participating patient prior to commencing the study.

Inclusion criteria comprised patients of both genders aged 20 years and above, diagnosed with gallbladder disease, and expressing willingness to participate [5, 6]. Written informed consent, particularly acknowledging the possibility of converting laparoscopic cholecystectomy to open cholecystectomy, was mandatory for inclusion.

Exclusion criteria involved patients displaying clinical features of obstructive jaundice, palpable gallbladder lumps, pregnant females, individuals with a perforated gallbladder, and those diagnosed with gallbladder carcinoma or any other malignancy, as detailed in previous studies [7, 8].

Each patient underwent comprehensive clinical history gathering and collection of previous treatment records, followed by a thorough clinical examination. Preoperative investigations, including a complete blood count (CBC), bleeding time/coagulation time (BT/CT), random blood sugar (RBS), liver function tests (LFT), renal function tests (RFT), serum amylase, serum lipase, urine analysis, HIV testing, HBsAg, HCV screening, electrocardiogram (ECG), and chest X-ray (PA view), were conducted.

Abdominal ultrasound was performed for all cases, and additional imaging studies such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) were conducted for select patients [9, 10]. Laparoscopic cholecystectomies were performed by the consultant surgeon. Operative findings and reasons for any conversion were meticulously recorded and analyzed. Furthermore, all excised gallbladder specimens resulting from cholecystectomy underwent histopathological examination.

Among the 200 cases that underwent laparoscopic cholecystectomy, 58% were males, and 42% were females, see Table 1. When examining gender-wise distribution, it was observed that the incidence of conversion to open cholecystectomy was higher in male patients, accounting for 66%, compared to female patients, where it was 33%. There were nine conversions in total, resulting in a conversion rate of 9%. Among the patients, the majority, comprising 70%, fell into the age group of 30 to 60 years, see Table 2. About 27% of the patients were above 60 years of age, and a smaller percentage, 3%, were under 30 years old6. Notably, patients in the age group of 30 to 60 years had a higher conversion rate, which stood at 77%.

Among the total 200 patients, the duration of surgery was as follows:less than 60 minutes for 20% of the patients, between 60 to 90 minutes for 56% of the patients, and more than 90 minutes for 34% of the patients. Notably, the nine patients who required conversion to open surgery had a longer duration of surgery, resulting in an extended post-operative stay [11, 12, 13, 14]. Among the 18 patients who underwent conversion, the reasons for conversion were distributed as follows:

• Intraoperative adhesions were the most common cause, identified in 8 patients,
• CBD (common bile duct) injury and bleeding from the cystic artery were each found in 2 patients,
• Bowel injury and unclear anatomy were observed in 1 patient each,
• Additionally, spillage of gallstones was identified in 1 patient as well.

These findings shed light on the various factors that led to the conversion of laparoscopic cholecystectomy to open cholecystectomy in the study [14, 15].

Table 1. Gender wise Distribution of Cases

Gender	N	%
Male	58	58
Female	42	42
Total	100	100

 

Table 2. Age wise Distribution of Cases

Age(years)	N	%
<30	3	3
30-60	70	70
>60	27	27
Total	100	100

Figure 1: Reasons for Conversion

The preferred treatment for gall bladder disease is laparoscopic cholecystectomy, regarded as the gold standard. It is crucial to emphasize that opting to switch from a laparoscopic approach to an open technique is not deemed a failure but rather a proactive step to mitigate potential complications. This strategy prioritizes patient safety and the overall success of the surgical procedure [16, 17].

An analysis of 200 patients in your study revealed a predominant male representation, constituting 58% of the total cohort, while the remaining 42% were females. This gender distribution highlighted a higher prevalence of gallstone disease among male participants. Furthermore, our investigation indicated that male patients exhibited a greater rate of conversion compared to their female counterparts. Nonetheless, this disparity did not yield a statistically significant p-value. This observation aligns with findings from Dalal et al. [18], where the conversion rate stood at 19.67% among males and 5.84% among females, showing a moderately significant association (\(p=0.048\)) with male gender. However, this contradicts the results obtained in the study conducted by Mallik et al. [9] which reported a higher conversion rate among female patients.

Gallbladder disease can affect individuals across various age brackets, but its prevalence tends to be higher in the fourth, fifth, and sixth decades of life. In your investigation, patients undergoing laparoscopic cholecystectomy ranged from a minimum age of 19 years to a maximum of 83 years. The majority, comprising 72%, fell within the age bracket of 30 to 60 years. Approximately 25% were aged 60 years and above, with a smaller proportion (3%) below 30 years old. This distribution underscores the inclination for gallbladder disease to be more prevalent among middle-aged and older individuals.

Laparoscopic cholecystectomy remains the "gold standard" procedure for treating cholecystectomy. Decisions regarding the conversion from laparoscopic to open cholecystectomy should be made based on the surgeon’s informed clinical judgment rather than a lack of individual expertise. Such conversions should not be considered failures, but essential steps are taken to enhance patient safety and increase the chances of a successful outcome. Surgeons should receive appropriate training and support to ensure proficiency in performing open cholecystectomy when necessary, highlighting the importance of ongoing education and skill development.

This research paper received no external funding.

The authors declare no conflicts of interest.

All authors contributed equally to this paper. They have all read and approved the final version.

Verbal informed consent was obtained from all participates in the study as needed.

1. Fischer, J. E., Ellison, E. C., Upchurch, G. R., Galandiuk, S., Gould, J. C., Klimberg, V., Henke, P., Hochwald, S. N., & Tiao, G. M. (2018). Fischer's Mastery of Surgery, Seventh Edition. Wolters Kluwer Health Adis (ESP).
2. Al-Mulhim, A. A. (2008). Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: a single surgeon experience. Saudi Journal of Gastroenterology, 14(2), 73-79.
3. Bailey, H. (2018). Bailey & Love's Short Practice of Surgery} (27th ed.). Churchill Livingstone: Edinburgh.
4. Bingener-Casey, J., Richards, M. L., Strodel, W. E., Schwesinger, W. H., & Sirinek, K. R. (2002). Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. Journal of Gastrointestinal Surgery, 6(6), 800-805.
5. Ravimohan, S. M., Kaman, L., Jindal, R., Singh, R., & Jindal, S. K. (2005). Postoperative pulmonary function in laparoscopic versus open cholecystectomy: prospective, comparative study. Indian Journal of Gastroenterology, 24(1), 6-8.
6. Ghnnam, W., Malek, J., Shebl, E., Elbeshry, T., & Ibrahim. (2010). Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 30(2), 145-148.
7. Brunicardi, F., Andersen, D., Billiar, T., Dunn, D., Hunter, J., & Pollock, R. E. (2004). Schwartz's Principles of Surgery (8th ed.). McGraw-Hill Professional, 1187-1204.
8. Thyagarajan, M., Singh, B., Thangasamy, A., & Rajasekar, S. (2017). Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy. International Surgery Journal, 4(10), 3354-3357.
9. Mallik, N. R., Bhattacharyya, S., Saha, A. K., & Das, C. (2018). A study on the conversion rate of laparoscopic cholecystectomy to open cholecystectomy and its causes with special reference to rural population. IOSR Journal of Dental and Medical Sciences, 17(4), 51-57.
10. Al Ghadhban, M. R., Alkumasi, H. A., & Meziad, M. S. (2018). Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital. International Surgery Journal, 5(5), 1640-1643.
11. Karigalan, K., & Haripriya, R. (2014). A study on safety and efficacy of laparoscopic cholecystectomy in comparison to open cholecystectomy. Journal of Evolution of Medical and Dental Sciences, 3(17), 4721-4731.
12. Awan, N. A., Hamid, F., Mir, I. N., Ahmad, M. M., Shah, A. A., Asimi, A., ... & Wani, H. A. (2018). Factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy-institution based study. International Surgery Journal, 5(1), 132-137.
13. Reddy, S. R., & Balamaddaiah, G. (2016). Predictive factors for conversion of laparoscopic cholecystectomy to open cholecystectomy: a retrospective study. International Surgery Journal, 3(2), 817-820.
14. Yadav, P., Agarwal, S., Modhia, D., & Joshi, A. (2022). A study of factors associated with conversion of laparoscopic cholecystectomy to open cholecystectomy. International Surgery Journal, 9(6), 1198-1202.
15. Rashid, T., Naheed, A., Farooq, U., Iqbal, M., & Barakat, N. (2016). Conversion of laparoscopic cholecystectomy into open cholecystectomy: an experience in 300 cases. Journal of Ayub Medical College Abbottabad, 28(1), 116-119.
16. Agarwal, S., & Joshi, A. D. (2020). Perioperative complications of laparoscopic cholecystectomy: a cross-sectional observational study. International Surgery Journal, 7(5), 1490-1495.
17. Simopoulos, S. B. (2005). Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surgical Endoscopy, 19}, 905-909.
18. Dalal, A. S., Sharma, V. I., & Mathur, R. K. (2017). Study of factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Indian Journal of Basic and Applied Medical Research, 6(2), 24-30.