Laparoscopic cholecystectomy has been the gold standard in the management of Cholecystolithiasis since decades. However there are few cases which obviate the necessity for conversion to open procedure and prediction of these cases preoperatively has been a challenge to the surgical fraternity since years. Predicting the possibility of conversion to open procedure preoperatively with risk factors would result in optimum management of the patient.

Aim:To evaluate the preoperative risk factors implicated in conversion of laparoscopic to open cholecystectomy.

Methods: A total of 788 patients admitted to our tertiary care hospital duringJanuary 2013 to August 2017, were divided into opencholecystectomy (OC) and laparoscopiccholecystectomy group (LC) and treated with intent to cure. Data was collected retrospectivelyregarding age, gender, admission (Elective/Emergency), indications for Surgery (Acute/Chronic Cholecystitis/GB Polyp), co–morbid illness, previous surgery, preoperative ERCPand deranged LFT and statistically analysed.

Results:749 patients underwent LC and 39 patients were convertedinto open cholecystectomy.There was no significant difference in distribution of age, gender, preoperative LFT values, preoperative ERCP, co–morbid illness and previous surgery in either of the groups.   However, males aged >60 years (60%) were found to carry significant risk of conversion to open procedure. 30% patients (p <0.001) with acute cholecystitisunderwent conversion.Conversion rate of 4.9% (n=39) was noted in this study. The common cause for conversion was difficult calot’s triangle dissection which was seen in 64.1% (n=25) patients.

Conclusion:Emergency laparoscopic cholecystectomy for acute cholecystitis and elderly males aged >60 yrs are independent predictive preoperative risk factors for conversion of laparoscopic to open cholecystectomy. Preoperative ERCP, previous surgery, co–morbid illness and deranged LFT do not conclusively aid in prediction of conversion to open cholecystectomy.