Anatomical Factors Associated With Conversion from Laparoscopic To Open Cholecystectomy Surgery in Peadiatric and Adult Populations

Abstract

Background: Laparoscopic cholecystectomy is the usual surgical treatment for the symptomatic gallbladder disease for both children and adults. It has some advantages over laparotomy, but in some cases, laparotomy may be necessary due to anatomical difficulty or inflammatory distortion, which makes it unsafe for laparoscopic dissection. Dense adhesions, frozen Calot's triangle, impacted Hartmann's pouch stone, gangrenous gallbladder and unclear biliary anatomy may be risk factors for conversion.

Objective: To determine the anatomical factors associated with conversion from laparoscopic to open cholecystectomy surgery in pediatric and adult populations.

Methods: This is a descriptive, cross sectional study, which was conducted in Bannu Medical college, Bannu from January 2025 to June 2025. There were 75 patients undergoing attempted laparoscopic cholecystectomy. The patients were split into two groups: pediatrics and adults. The following information was collected: demographic data, clinical history, ultrasound findings, intra-operative anatomical findings, conversion status, reasons for conversion, operating time, and postoperative outcome. Conversions, which were considered when the laparoscopic procedure had to be abandoned and performed through an open incision. The SPSS software was used for data analysis. Categorical variables were presented as frequencies and percentages and continuous variables were presented as mean and standard deviation. Where applicable, Chi-Square test or Fisher's exact test was used, and a p value<0.05 was defined as significant.

Results: Out of 75 patients, 25 (33.3%) were pediatric and 50 (66.7%) were adults. The overall conversion rate from laparoscopic to open cholecystectomy was 12.0% (9/75). Conversion was more frequent in adults 14.0% (7/50) compared with pediatric patients 8.0% (2/25), although this difference was not statistically significant. The major anatomical factors significantly associated with conversion were dense adhesions around the gallbladder, frozen Calot’s triangle, difficult cystic duct identification, impacted stone at Hartmann’s pouch, gangrenous gallbladder, uncontrolled bleeding, and unclear biliary anatomy. Patients who required conversion had longer operative time and hospital stay compared with those completed laparoscopically.

Conclusion: Anatomical distortion and inflammatory changes around Calot’s triangle were the main factors associated with conversion from laparoscopic to open cholecystectomy. Conversion was more common among adults than pediatric patients. Early recognition of difficult anatomy, careful dissection, and timely conversion are important for preventing bile duct injury and improving patient safety.