Preoperative ultrasonographic predictors of conversion from laparoscopic to open cholecystectomy

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallbladder disease. However, conversion to open cholecystectomy (OC) is sometimes necessary and is associated with increased morbidity and healthcare costs. Identifying preoperative predictors of conversion is crucial for surgical planning and patient counseling. This study aimed to describe the preoperative radiological features in a series of patients who required conversion from LC to OC.
METHODS: We conducted a retrospective, single-center descriptive study at a tertiary training and research hospital. All patients (n=104) who underwent conversion from LC to OC between January 2020 and May 2025 were included. Preoperative ultrasonography (USG) findings, along with demographic, clinical, and intraoperative data, were systematically analyzed.
RESULTS: The most prevalent preoperative radiological findings were a hydropic gallbladder, identified in 59 patients (56.7%), gallbladder wall thickening (>4 mm) observed in 68 patients (65.4%), and pericholecystic fluid, observed in 55 patients (52.9%). The primary intraoperative reason for conversion was dense adhesions, reported in 62 patients (59.6%).
DISCUSSION AND CONCLUSION: Preoperative USG findings of a hydropic gallbladder and pericholecystic fluid are common in patients requiring conversion to OC and serve as important “warning signs” for a difficult procedure. These features, indicative of severe inflammation leading to adhesions, should prompt careful preoperative planning, patient counseling, and consideration of safe bailout strategies to maximize patient safety.

Keywords: Conversion, laparoscopic cholecystectomy, open cholecystectomy, ultrasonography