{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:04:24Z","timestamp":1779696264538,"version":"3.53.1"},"reference-count":21,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder disease, yet conversion to open cholecystectomy (OC) remains necessary in 2-15% of cases. Although often life-saving, conversion increases operative time, morbidity, and hospital stay. Identifying reliable predictors is therefore crucial for surgical planning and patient counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted on 4535 patients who underwent LC at a tertiary center between January 2018 and May 2024. Demographic, clinical, laboratory, radiological, intraoperative, and histopathological data were extracted from medical records. Univariate and multivariate logistic regression analyses were used to identify independent predictors of conversion. A nomogram was developed to estimate individualized conversion risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Conversion to OC occurred in 304 patients (6.7%). Independent predictors included male sex (OR 1.65, 95% CI 1.09-2.50), ASA IV classification (OR 4.84, 95% CI 2.51-9.33), elevated CRP (OR 1.007 per mg\/L, 95% CI 1.004-1.010), reduced lymphocyte count (OR 0.42, 95% CI 0.21-0.84), gastric or intestinal complications (OR 3.38, 95% CI 1.01-11.38), gangrenous gallbladder (OR 2.39, 95% CI 1.45-3.93), and xanthogranulomatous cholecystitis (OR 5.42, 95% CI 1.61-18.25). Gallbladder wall thickness was the strongest preoperative predictor (OR 1.20 per mm, 95% CI 1.13-1.27,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and existence of dense adhesions were the strongest intraoperative predictor (OR 26.77, 95% CI 16.64-43.07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Conversion to OC reflects anatomical complexity and advanced disease rather than surgical failure. Gallbladder wall thickness, inflammatory markers, adhesions, gangrene, and xanthogranulomatous cholecystitis are consistent predictors. The proposed nomogram provides individualized risk estimation to improve preoperative planning and patient counseling. Prospective multicenter validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15533506251413062","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T11:24:51Z","timestamp":1766575491000},"page":"234-243","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Conversion in Laparoscopic Cholecystectomy and Development of a Predictive Nomogram"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-7355","authenticated-orcid":false,"given":"Mehmet Berksun","family":"Tutan","sequence":"first","affiliation":[{"name":"Alaca State Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Topcu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Hitit University Faculty of Medicine, \u00c7orum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veysel Bar\u0131\u015f","family":"Turhan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Hitit University Faculty of Medicine, \u00c7orum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim Tayfun","family":"\u015eahiner","sequence":"additional","affiliation":[{"name":"Medical Point Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-005-0612-x"},{"key":"e_1_3_6_3_2","first-page":"318","article-title":"Risk factors for acute cholecystitis and for intraoperative complications","volume":"88","author":"Andercou O","year":"2017","unstructured":"Andercou O, Olteanu G, Mihaileanu F, Stancu B, Dorin M. Risk factors for acute cholecystitis and for intraoperative complications. Ann Ital Chir. 2017;88:318-325.","journal-title":"Ann Ital Chir"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-009-0338-1"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2024.0366"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(97)00005-6"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.4274\/BMJ.galenos.2023.2023.1-18"},{"key":"e_1_3_6_8_2","first-page":"8","article-title":"Can hemogram parameters and derived ratios predict conversion from laparoscopic to open cholecystectomy?","volume":"16","author":"Avci MA","year":"2024","unstructured":"Avci MA, Akgun C, Buk O, Karadan D. Can hemogram parameters and derived ratios predict conversion from laparoscopic to open cholecystectomy? Cureus J Med Sci. 2024;16:8.","journal-title":"Cureus J Med Sci"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1996.01430130100022"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-001-0008-4"},{"key":"e_1_3_6_11_2","first-page":"141","article-title":"Predictive score for conversion in laparoscopic cholecystectomy - a prospective study","volume":"41","author":"Teja VS","year":"2025","unstructured":"Teja VS, Ramakrishnan R, Srinivasan JP. Predictive score for conversion in laparoscopic cholecystectomy - a prospective study. Turk J Surg. 2025;41:141-146.","journal-title":"Turk J Surg"},{"key":"e_1_3_6_12_2","first-page":"13","article-title":"Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study","volume":"15","author":"Wu HS","year":"2025","unstructured":"Wu HS, Ma KQ, Liao BL, et al. Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study. Sci Rep. 2025;15:13.","journal-title":"Sci Rep"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.947950"},{"key":"e_1_3_6_14_2","first-page":"7","article-title":"Laparoscopic conversion to open cholecystectomy: is incidental gallbladder cancer any different?","volume":"16","author":"Silva TS","year":"2024","unstructured":"Silva TS, Firek M, Albini P, Molina DC. Laparoscopic conversion to open cholecystectomy: is incidental gallbladder cancer any different? Cureus J Med Sci. 2024;16:7.","journal-title":"Cureus J Med Sci"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s44411-025-00228-z"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(02)00934-0"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.21037\/asj-24-41"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.62713\/aic.4073"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/00031348251351000"},{"key":"e_1_3_6_20_2","first-page":"1275","article-title":"Factors effecting the complications in the natural history of acute cholecystitis","volume":"48","author":"Bedirli A","year":"2001","unstructured":"Bedirli A, Sakrak \u00d6, S\u00f6z\u00fcer EM, Kerek M, G\u00fcler I. Factors effecting the complications in the natural history of acute cholecystitis. 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