Degree of Gallbladder Adhesion as a Predictor for Common Bile Duct Injury and Conversion to Open in Laparoscopic Cholecystectomy

Background: Gallbladder adhesions encountered during Laparoscopic Cholecystectomy can distort biliary anatomy, increasing the risk of iatrogenic injury and conversion to open surgery. This study evaluates the predictive value of adhesion severity on surgical outcomes. Objectives: This study aimed to assess the degree of gallbladder adhesion, predict the risk of common bile duct injury, and determine the likelihood of conversion to open cholecystectomy. Patients And Methods: This analysis was conducted on ninety patients admitted for elective laparoscopic cholecystectomy at a tertiary care hospital. Data were collected on accrual. Adhesions were graded intraoperatively into four tiers based on severity and anatomical involvement. Primary outcomes were conversion rates and common bile duct injuries. Results: Severe adhesions (>50% or buried gallbladder) were present in 34.4% of patients. The overall conversion rate was 8.9%, which rose to 44.4% in patients with a completely buried gallbladder (p=0.001). Common bile duct injury occurred in 5.6% of patients, with the highest incidence (22.2%) in the most severe adhesion group (p=0.026). Increasing adhesion severity was significantly associated with longer operative times and greater intraoperative blood loss (p<0.001). Conclusion: The intraoperative degree of gallbladder adhesion is a significant predictor of conversion to open surgery and common bile duct injury. Asystematic assessment of adhesions is crucial for intraoperative risk stratification and decision-making to ensure patient safety