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Deari Ahmed Ismaeil a, Barham M. M. Salih a and Karzan Seerwan Abdulla a

a Department of Surgery, College of Medicine, University of Sulaimani. 

Submitted: 15/3/2017; Accepted: 15/10/2017; Published: 1/11/2017


Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy, mainly because of technical difficulty. 


To identify the prediction of difficult laparoscopic cholecystectomy.

Materials and Methods

Preoperative clinical, laboratory, and radiologic parameters of 249 patients, who underwent laparoscopic cholecystectomy, were analyzed for their technical difficulty. Parameters (male sex, abdominal tenderness, previous upper abdominal operation, sonographically thickened gallbladder wall, age over 65 years, preoperative diagnosis of acute cholecystitis, history of ERCP) were found to have significant effect in multivariate analysis.


Overall 54 operations (21.7%) were difficult; 36 operations (14.5%) took long time and 18 patients (7.2%) required conversion to open cholecystectomy. 


Conversion risk can be predicted to some extent. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.


Cholelithiasis; Laparoscopic cholecystectomy, Risk factor.

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