Laparoscopic Cholecystectomy to Open Cholecystectomy in Sulaymaniyah Teaching Hospital, Incidence and Risk Factors Assessment

Background: Laparoscopic cholecystectomy (LC) is nowadays a standard procedure for the treatment of cholelithiasis; however still in some circumstances, it might become necessary to proceed to open cholecystectomy (OC). Aim: To assess the incidence and risk factors of conversion of LC to OC in Sulaymaniyah teaching hospital. Method: A prospective study includes 485 patients who underwent LC, from April 1st, 2019 to October 1st, 2019. The data collected by taking the proper history, careful examination, recording hematological, radiological and endoscopic results and operative findings. Results: From 485 patients, 383 were females and 102 were males, with a mean age of (42.43 +/- 13.31) years. Twenty-two cases (4.5%) were converted into OC. The causes of conversion were dense adhesions and disturbed anatomy at Calot's triangle in 12 cases, bowel injury and bilio-digestive fistula in 4 cases, bile duct injury in 2 cases, bleeding in 2 cases, anatomical variation in 1 patient, and suspicious mass near gallbladder wall in 1 patient. Diabetic patients had higher rates of conversion than non-diabetic patients, (19.6%) compared to (2.56%). Conclusion: The presence of dense and extensive adhesions at Calot's triangle is the commonest cause of conversion. Other risk factors included: age above 50 years, male gender, BMI more than 30, history of gall stone pancreatitis, history of upper abdominal surgery, and DM.