To investigate the causes and prevention of conversion to laparotomy during laparoscopic cholecystectomy.

Clinical data of 30 out of 770 patients converting to laparotomy during laparoscopic cholecystectomy in Guangdong Chaozhou Central Hospital from February 2007 to January 2013 were analyzed retrospectively. There were 13 males and 17 females with age ranging from 25 to 81 years old and a median age of 48 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Laparoscopic cholecystectomy was performed in the patients under endotracheal general anesthesia using the conventional 4-port approach. The causes of conversion to laparotomy during laparoscopic cholecystectomy and the incidence of postoperative complications of the patients were observed.

The incidence of conversion to laparotomy during laparoscopic cholecystectomy was 3.9% (30/770). The causes of conversion to laparotomy were adhesion at Calot's triangle (n=12), gallbladder bed bleeding (n=6), gallbladder artery bleeding (n=4), dense adhesion around the gallbladder with difficult dissecting (n=4), dissatisfactory treatment of the gallbladder stump (n=1), liver surface laceration (n=1), gallbladder carcinoma (n=1). All the converted laparotomies were completed at one time. No complication was observed in all patients after operation.

The common causes for conversion to laparotomy during laparoscopic cholecystectomy were unclear dissection at Calot's triangle and around the gallbladder, gallbladder bed or gallbladder artery bleeding, dissatisfactory treatment of gallbladder stump, liver surface laceration, gallbladder cancer, etc. Improving the preoperative evaluation, intraoperative appropriate treatment of the Calot's triangle and gallbladder bed are the keys to prevent conversion to laparotomy during laparoscopic cholecystectomy.