الفهرس 
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Abstract
Background: Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiaisis but there are still some patients requiring conversion to open cholecystectomy. <U+00AC>Aim of work: The aim of this study is to carry a prospective and retrospective analysis of cases which have been converted to open cholecystectomy and the change in incidence of conversion and its correlation with increased training Patients and methods: Retrospective and prospective study of 180 patients to whom laparoscopic cholecystectomy was decided to be performed during the period from January 2002 to May 2005 in our surgical department in Mansoura University Hospital. Results: In our study which was carried on 180 patients in the period from January 2002 to May 2005, it included both retrospective and prospective analysis of patients data. The number of patients that has been converted to open cholecystectomy was 12 patients (6.67%). In our study, upper abdominal scar was found in two patients (1.1%) and lower abdominal scar for previous caesarian section was found in three patients (1.7%). Appendectomy scar was found in 5 patients (2.8%). Only 1 case was converted due to upper abdominal scar (0.55%). In our study, two patients were converted (1.1%) due to injury of CBD, one of them was found to have incomplete cut between two clips and it was managed by suture around a T tube stent. The other case was found to have complete cut with upward migration of the common hepatic duct and was managed by RouxenY hepatidocojejunostomy. One case was converted (0.55%) due to stapled CBD, on conversion to open cholecystectomy the clip was removed and cholecystectomy was completed with Ttube drainage of CBD. Four cases were converted to open due to difficulty in the dissection of Calot<U+2019>s triangle ratio (2.2%). Two cases were converted to open (1.1%) due to large tense gall bladder with large stone impacted in Hartman<U+2019>s pouch. In our study 1 case was converted due to bleeding from gall bladder bed and cirrhotic liver ratio (0.55%), but in other patients with liver cirrhosis haemostasis was carried out easier as bleeding sites were magnified and better managed by laparoscope. Conclusions: Conversion to open cholecystectomy is based on surgeon<U+2019>s decision and the safety should be the main consideration in performing laparoscopic cholecystectomy. So that if during the laparoscopic procedure the mentioned risk factors apparent, it is better to convert to open.