{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:09:44Z","timestamp":1792505384307,"version":"4.5.0"},"reference-count":55,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Laparoscopic cholecystectomy is a standard treatment for patients with gallstones in the gallbladder. However, multiple risk factors affect the probability of conversion from laparoscopic cholecystectomy to open surgery. A greater understanding of the preoperative factors related to conversion is crucial to improve patient safety. In the present systematic review, we summarized the current knowledge about the main factors associated with conversion. Next, we carried out several meta-analyses to evaluate the impact of independent clinical risk factors on conversion rate. Male gender (OR = 1.907; 95%CI = 1.254\u20132.901), age &gt; 60 years (OR = 4.324; 95%CI = 3.396\u20135.506), acute cholecystitis (OR = 5.475; 95%CI = 2.959\u201310.130), diabetes (OR = 2.576; 95%CI = 1.687\u20133.934), hypertension (OR = 1.931; 95%CI = 1.018\u20133.662), heart diseases (OR = 2.947; 95%CI = 1.047\u20138.296), obesity (OR = 2.228; 95%CI = 1.162\u20134.271), and previous upper abdominal surgery (OR = 3.301; 95%CI = 1.965\u20135.543) increased the probability of conversion. Our analysis of clinical factors suggested the presence of different preoperative conditions, which are non-modifiable but could be useful for planning the surgical scenario and improving the post-operatory phase.<\/jats:p>","DOI":"10.3390\/ijerph20010408","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:45:54Z","timestamp":1672116354000},"page":"408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Preoperative Risk Factors for Conversion from Laparoscopic to Open Cholecystectomy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2023-2135","authenticated-orcid":false,"given":"Roberta","family":"Magnano San Lio","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-5003","authenticated-orcid":false,"given":"Martina","family":"Barchitta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2655-8574","authenticated-orcid":false,"given":"Andrea","family":"Maugeri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serafino","family":"Quartarone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Basile","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-8162","authenticated-orcid":false,"given":"Antonella","family":"Agodi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.asjsur.2020.11.018","article-title":"The pre-operative predictive model for difficult elective laparoscopic cholecystectomy: A modification","volume":"44","author":"Tongyoo","year":"2021","journal-title":"Asian J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s12262-017-1622-2","article-title":"Open Cholecystectomy Has a Place in the Laparoscopic Era: A Retrospective Cohort Study","volume":"79","author":"Mahdy","year":"2017","journal-title":"Indian J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Warcha\u0142owski, \u0141., \u0141uszczki, E., Bartosiewicz, A., Dere\u0144, K., Warcha\u0142owska, M., Oleksy, \u0141., Stolarczyk, A., and Podlasek, R. (2020). The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17207571"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1007\/s00268-018-4513-1","article-title":"Predicting Conversion from Laparoscopic to Open Cholecystectomy: A Single Institution Retrospective Study","volume":"42","author":"Shaib","year":"2018","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s13304-017-0494-0","article-title":"Prognostic risk factors for conversion in laparoscopic cholecystectomy","volume":"70","author":"Aguirre","year":"2018","journal-title":"Updates Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.amjsurg.2017.07.029","article-title":"Risk factors for conversion of laparoscopic cholecystectomy to open surgery\u2013A systematic literature review of 30 studies","volume":"214","author":"Hu","year":"2017","journal-title":"Am. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/S0002-9610(01)00633-X","article-title":"A risk score for conversion from laparoscopic to open cholecystectomy","volume":"181","author":"Kama","year":"2001","journal-title":"Am. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3068","DOI":"10.1007\/s00464-010-1091-1","article-title":"Sex differences in laparoscopic cholecystectomy","volume":"24","author":"Thesbjerg","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/145749691110000306","article-title":"Risk factors for conversion during laparoscopic cholecystectomy\u2013experiences from a general teaching hospital","volume":"100","author":"Alexander","year":"2011","journal-title":"Scand. J. Surg."},{"key":"ref_10","first-page":"197","article-title":"Laparoscopic cholecystectomy in obese patients compared with nonobese patients","volume":"5","author":"Angrisani","year":"1995","journal-title":"Surg. Laparosc. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1007\/s004640000019","article-title":"Laparoscopic cholecystectomy in morbidly obese patients","volume":"15","author":"Ammori","year":"2001","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1155\/1998\/35456","article-title":"The feasibility of laparoscopic cholecystectomy in patients with previous abdominal surgery","volume":"10","author":"Diez","year":"1998","journal-title":"HPB Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00464-003-9001-4","article-title":"Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery","volume":"18","author":"Karayiannakis","year":"2004","journal-title":"Surg. Endosc."},{"key":"ref_14","first-page":"419","article-title":"Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy and the Usefulness of the 2013 Tokyo Guidelines","volume":"71","author":"Utsumi","year":"2017","journal-title":"Acta Med. Okayama"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.gassur.2005.12.001","article-title":"Conversions during laparoscopic cholecystectomy: Risk factors and effects on patient outcome","volume":"10","author":"Tang","year":"2006","journal-title":"J. Gastrointest. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1159\/000445505","article-title":"Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery\u2013A Systematic Review and Meta-Analysis of Observational Studies","volume":"33","author":"Burcharth","year":"2016","journal-title":"Dig. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.surg.2007.07.010","article-title":"Preoperative findings predict conversion from laparoscopic to open cholecystectomy","volume":"142","author":"Lipman","year":"2007","journal-title":"Surgery"},{"key":"ref_18","unstructured":"Wells, G.A., O\u2019Connell, D., Peterson, J., Welch, V., and Losos, M. (2022, November 01). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality If Nonrandomized Studies in Meta-Analyses. Available online: https:\/\/www.scienceopen.com\/document?vid=54b48470-4655-4081-b5d4-e8ebe8d1792e."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/ases.12301","article-title":"Preoperative hypoalbuminemia is an independent risk factor for conversion from laparoscopic to open cholecystectomy in patients with cholecystolithiasis","volume":"9","author":"Ishizuka","year":"2016","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_22","first-page":"60","article-title":"Preoperative risk factors for conversion from laparoscopic to open cholecystectomy","volume":"18","author":"Licciardello","year":"2014","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00464-004-2197-0","article-title":"Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy","volume":"19","author":"Simopoulos","year":"2005","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gholipour, C., Fakhree, M.B., Shalchi, R.A., and Abbasi, M. (2009). Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surg., 9.","DOI":"10.1186\/1471-2482-9-13"},{"key":"ref_25","first-page":"17","article-title":"Conversion from laparoscopic to open cholecystectomy: Multivariate analysis of preoperative risk factors","volume":"51","author":"Tayeb","year":"2005","journal-title":"J. Postgrad. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.amjsurg.2018.03.016","article-title":"External validation of the Cairns Prediction Model (CPM) to predict conversion from laparoscopic to open cholecystectomy","volume":"216","author":"Hu","year":"2018","journal-title":"Am. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1007\/s004649900826","article-title":"Can sonographic signs predict conversion of laparoscopic to open cholecystectomy?","volume":"12","author":"Berger","year":"1998","journal-title":"Surg. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/j.1445-2197.2008.04714.x","article-title":"Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy","volume":"78","author":"Zhang","year":"2008","journal-title":"ANZ J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/bjs.5406","article-title":"Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004","volume":"93","author":"Ishizaki","year":"2006","journal-title":"Br. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1089\/lap.2009.0457","article-title":"Predictive factors for conversion to open surgery in patients undergoing elective laparoscopic cholecystectomy","volume":"20","author":"Ercan","year":"2010","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1590\/S1807-59322011000300009","article-title":"What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations","volume":"66","author":"Genc","year":"2011","journal-title":"Clinics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.surge.2012.11.001","article-title":"Beware the contracted gallbladder\u2013Ultrasonic predictors of conversion","volume":"11","author":"Myers","year":"2013","journal-title":"Surgeon"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/S0002-9610(02)00934-0","article-title":"Predictive factors for conversion of laparoscopic cholecystectomy","volume":"184","author":"Rosen","year":"2002","journal-title":"Am. J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/PL00012288","article-title":"Predictive factors for conversion of laparoscopic cholecystectomy","volume":"21","author":"Alponat","year":"1997","journal-title":"World J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"581","DOI":"10.4293\/108680809X1258998404560","article-title":"Factors influencing the successful completion of laparoscopic cholecystectomy","volume":"13","author":"Chandio","year":"2009","journal-title":"JSLS"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3174","DOI":"10.1007\/s00464-012-2310-8","article-title":"The degree of gallbladder wall thickness and its impact on outcomes after laparoscopic cholecystectomy","volume":"26","author":"Raman","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1089\/lap.2016.0008","article-title":"Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery: A New Predictive Statistical Model","volume":"26","author":"Beksac","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_38","first-page":"5231","article-title":"A retrospective analysis of incidence of transformation of laproscopic cholecystectomy into open cholecystectomy","volume":"6","author":"Zulfiqar","year":"2019","journal-title":"Indo Am. J. Pharm. Sci."},{"key":"ref_39","first-page":"98","article-title":"Factors Affecting Conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy at a Tertiary Care Facility in Saudi Arabia: A Cross-Sectional Study","volume":"131","author":"Nouh","year":"2019","journal-title":"Int. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s12262-019-02033-9","article-title":"A New Preoperative Scoring System to Predict Difficulty of Laparoscopic Cholecystectomy and Risk of Conversion to Open Surgery","volume":"82","author":"AbdelDayem","year":"2019","journal-title":"Indian J. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s00464-001-0008-4","article-title":"Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery","volume":"15","author":"Kama","year":"2001","journal-title":"Surg. Endosc."},{"key":"ref_42","first-page":"97","article-title":"Gender as a predictive factor in cholecystectomy\u2013is it true or false?","volume":"60","author":"Osuch","year":"2020","journal-title":"Folia Med. Cracov."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.amjsurg.2009.08.020","article-title":"Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals","volume":"200","author":"Kaafarani","year":"2010","journal-title":"Am. J. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.hpb.2016.07.015","article-title":"Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: A validated risk score derived from a prospective U.K. database of 8820 patients","volume":"18","author":"Sutcliffe","year":"2016","journal-title":"HPB"},{"key":"ref_45","first-page":"59","article-title":"A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography","volume":"6","author":"Lal","year":"2002","journal-title":"J. Soc. Laparoendosc. Surg."},{"key":"ref_46","first-page":"1244","article-title":"Laparoscopic Cholecystectomy to Open Cholecystectomy in Sulaymaniyah Teaching Hospital, Incidence and Risk Factors Assessment","volume":"14","author":"Faraj","year":"2020","journal-title":"Pak. J. Med. Health Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"256","DOI":"10.14260\/jemds\/2016\/54","article-title":"Factors affecting conversion of laparoscopic cholecystectomy to open surgery in a tertiary hospital in south india","volume":"5","author":"Kumar","year":"2016","journal-title":"J. Evol. Med. Dent. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.14260\/jemds\/2018\/607","article-title":"Preoperative clinical and radiological assessment in predicting difficult laparoscopic cholecystectomy- a study at government general hospital, guntur","volume":"7","author":"Naik","year":"2018","journal-title":"J. Evol. Med. Dent. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.amjsurg.2015.04.003","article-title":"Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors","volume":"210","author":"Goonawardena","year":"2015","journal-title":"Am. J. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1007\/s004649900237","article-title":"Laparoscopic management of acute cholecystitis. Prognostic factors for success","volume":"10","author":"Bickel","year":"1996","journal-title":"Surg. Endosc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/BF00188477","article-title":"Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?","volume":"10","author":"Zisman","year":"1996","journal-title":"Surg. Endosc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0002-9610(94)90051-5","article-title":"Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy","volume":"167","author":"Fried","year":"1994","journal-title":"Am. J. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0002-9610(05)80121-7","article-title":"Reasons for conversion from laparoscopic to open cholecystectomy in an urban teaching hospital","volume":"168","author":"Peters","year":"1994","journal-title":"Am. J. Surg."},{"key":"ref_54","first-page":"696","article-title":"Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy","volume":"179","author":"Sanabria","year":"1994","journal-title":"J. Am. Coll. Surg."},{"key":"ref_55","first-page":"958","article-title":"Evaluation of Preoperative Risk Factor for Converting Laparoscopic to Open Cholecystectomy: A Meta-Analysis","volume":"61","author":"Yang","year":"2014","journal-title":"Hepatogastroenterology"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/408\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:52:18Z","timestamp":1760147538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,27]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010408"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010408","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,27]]}}}