Background: Conversion from laparoscopic to open cholecystectomy is associated with increased morbidity. A low conversion rate, together with a low complication rate, may serve as a surrogate marker of surgical quality. This study aimed to analyze the conversion rate at a secondary referral center in relation to bile duct injuries and to identify risk factors associated with conversion. Methods: We performed a retrospective analysis of all laparoscopically initiated cholecystectomies between January 2013 and December 2022. Demographic and clinical data, surgical indication, timing, difficulty level (Nassar and Randhawa scores), conversion rates, and bile duct injuries (Neuhaus system) were evaluated. Results: A total of 1534 laparoscopic cholecystectomies were performed. The overall conversion rate was 2.0% ( n = 31), with 84% of conversions occurring in emergency cases. Converted patients showed a high prevalence of known risk factors. Most converted cholecystectomies (80.6%) were performed during daytime hours; only 6.5% of conversions occurred after midnight. The incidence of bile duct injuries was 0.26%, well below the average reported in the literature. Conclusion: A low conversion rate combined with a low rate of bile duct injuries can serve as a surgical quality indicator. Risk stratification using established scoring systems, laparoscopic skills such as intraoperative cholangiography, appropriate timing of surgery, and team composition may contribute to achieving a low conversion rate.
Schwarz et al. (2026) studied this question.