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Background <p>Conversion 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.</p> Objectives <p>To determine the conversion rate in an Iraqi cohort, identify independent preoperative predictors, develop a simplified risk score, and systematically categorize intraoperative conversion reasons.</p> Methods <p>A 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).</p> Results <p>Conversion 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, <i>p</i> = 0.002), prior abdominal surgery (aOR 1.65, 95% CI 1.05–2.60, <i>p</i> = 0.030), and ASA class III (aOR 1.80, 95% CI 1.00–3.25, <i>p</i> = 0.049) were independent predictors. Urgent-elective status was not independently associated with conversion (aOR 1.12, 95% CI 0.68–1.85, <i>p</i> = 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&#xa0;min without safe progression (12.6%).</p> <p>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.</p> Conclusions <p>In 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.</p>

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Predictors and reasons for conversion of laparoscopic to open cholecystectomy: a five-year cohort study

  • 期刊论文

  • 发表日期：

    2026年5月7日

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  • Kasim O. Hussein Al-Ali,
  • Haider Y. Naeif Kurkoosh,
  • Mohammed Mohaibes,
  • Abbas Khudhair Hadi,
  • Ammar Sabar

摘要

Background

Conversion 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.

Objectives

To determine the conversion rate in an Iraqi cohort, identify independent preoperative predictors, develop a simplified risk score, and systematically categorize intraoperative conversion reasons.

Methods

A 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).

Results

Conversion 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.

Conclusions

In 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.