Abstract
Background: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common.
 Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among patient suffering from gall bladder disease, and to explore the most common causes of conversion from laparoscopic to open cholecystectomy.
 Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, history of previous abdominal scar, common bile duct stone, ERCP, duration of symptom was included in our study.
 Results: Seven hundreds twenty –seven patients 74.48% were females and 191 26.52% were males. The mean age of patient presented with gall bladder disease was 40.43 years. Thirty –eight patients were converted to open cholecystectomy. The most common cause of conversation was dense adhesions 42.1% - followed by bleeding 30.1%. Other common causes of conversion were biliary anomalous anatomy 10.5%, common bile injury 5%, visceral injury and technical failure 7%.
 Conclusion: The main perioperative cause for OC was dense adhesion around gall bladder and the male gender, increasing age, history of common bile duct stone removed by previous ERCP, history of previous surgery, are independent risk factors of difficult laparoscopic cholecystectomy.
Highlights
Cholithiasis is one of the most common disease affecting human beings
The complications occur during laparoscopic cholecystectomy (LC) are numerous: some are specific to this unique technique and are common to laparoscopic surgery in general; these include complications related to anesthesia ;complication related to peritoneal access e.g. Vascular injury, visceral injury -; complication related to pneumopreitonium e.g., cardiac complication, pulmonary complication, and gas embolism ; and complication related to thrombocoagulation
Nine hundred and twenty patients were exposed to laparoscopic cholecystectomy, 38 (4.1%) of them were converted from the LC to open cholecystectomy (OC)
Summary
Cholithiasis is one of the most common disease affecting human beings. Langenbach in 1982 performed the first cholecystectomy (1) , but the first successful LC done in 1985 by Eric Muhe. Over the past two decades, laparoscopic cholecystectomy (LC) had become most popular procedure for surgical treatment of gall bladder disease. The benefit of LC over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses, lower rate of wound infection and post-operative ileus and cost effective (2). Patient factors and some unexpected adverse event during laparoscopic cholecystectomy lead to the conversion from LC to open cholecystectomy (3). Surgeon denial to convert will lead to a higher postoperative complications and the longer hospital stay in addition to the effect and long term sequel of cause of conversion itself as bile duct injury (4). Conversion to open cholecystectomy is occasionally necessary to ovoid or to repair injury, delineate confusing anatomy relationships, or treat associated conditions (5)
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