ArticleSurgical endoscopy2026
Predictors and reasons for conversion of laparoscopic to open cholecystectomy: a five-year cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundConversion from laparoscopic to open cholecystectomy (LC to OC) is an important surgical outcome that reflects procedural complexity and patient risk. While conversion predictors have been studied internationally, context-specific data from Iraq remain limited.
objectivesTo determine the conversion rate in an Iraqi cohort, identify independent preoperative predictors, develop a simplified risk score, and systematically categorize intraoperative conversion reasons.
methodsA retrospective cohort study was conducted on 945 consecutive patients who underwent LC between December 2020 and December 2025 at Al-Hussein Teaching Hospital, Iraq. All cases were either purely elective procedures for symptomatic gallstone disease or urgent-elective cases (patients with acute cholecystitis treated conservatively then operated 3-7 days after symptom onset).
resultsConversion occurred in 87 of 945 cases (9.2%; 95% CI 7.4-11.2%). Male sex (adjusted odds ratio [aOR] 2.10, 95% CI 1.30-3.40, p = 0.002), prior abdominal surgery (aOR 1.65, 95% CI 1.05-2.60, p = 0.030), and ASA class III (aOR 1.80, 95% CI 1.00-3.25, p = 0.049) were independent predictors. Urgent-elective status was not independently associated with conversion (aOR 1.12, 95% CI 0.68-1.85, p = 0.650). The most common intraoperative reasons for conversion were technical factors: laparoscopic decompression or aspiration was attempted but inadequate to achieve safe dissection in cases of distended or thick-walled gallbladder (16.1%), gallbladder neck stones with severe inflammation (13.8%), and dense adhesions from prior surgery with attempted laparoscopic adhesiolysis exceeding 20-30 min without safe progression (12.6%). In 17 cases (19.5%), these cases were included in the primary analysis because the underlying surgical indication was present. Surgeon-documented procedural limitations related to informed consent documentation (19.5%) were also identified.
conclusionsIn this Iraqi cohort, the LC-to-OC conversion rate was 9.2%. Male sex, prior abdominal surgery, and higher ASA classification were key preoperative predictors. The simplified risk score provides a pragmatic tool for preoperative risk stratification in resource-limited settings.
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