Vol. 1 No. 2 (2026): CONVERSION FROM LAPAROSCOPIC TO OPEN SURGERY IN ELECTIVE CHOLECYSTECTOMY: A CLINICAL AUDIT ON COMPLIANCE WITH INTERNATIONAL GUIDELINES AND IMPLICATIONS FOR QUALITY IMPROVEMENT
Vol. 1, Issue No. 2 | July 2026
Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease, offering faster recovery and reduced postoperative morbidity compared with open surgery. However, conversion to open cholecystectomy remains an essential safety strategy in cases where difficult anatomy or complex biliary pathology prevents safe laparoscopic dissection. Evaluating when and why conversion occurs is fundamental to maintaining high standards of surgical care and patient safety.
This original research article in the Journal of the European Society of Surgery (JESS) presents a clinical audit conducted at NMC Al Nahda Specialty Hospital, Dubai, United Arab Emirates, assessing compliance with internationally recognized SAGES and WSES guidelines for elective laparoscopic cholecystectomy. The audit reviewed elective procedures performed between January and September 2025, examining conversion rates, documentation practices, intraoperative decision-making, adherence to the Critical View of Safety (CVS), and quality improvement measures. The findings demonstrated an elective conversion rate of 2.48%, well below the internationally accepted benchmark of 5%, with all conversions supported by appropriate clinical indications, including dense adhesions, unclear biliary anatomy, failure to achieve the Critical View of Safety, and complex biliary pathology.
The audit concludes that conversion to open surgery should be recognized as a proactive safety decision rather than a surgical complication. While overall compliance with international guidelines was excellent, the study also identified opportunities to strengthen operative documentation, communication protocols, and preoperative risk assessment through structured quality improvement initiatives. This publication provides valuable insights for general surgeons, hepatobiliary surgeons, surgical trainees, clinical auditors, and healthcare professionals committed to enhancing patient safety, surgical governance, and evidence-based quality improvement in gallbladder surgery.
