Sometimes, it may be necessary to perform an X-ray, called a cholangiogram, to identify
stones, which may be located in the bile channels, or to ensure that structures have
been identified. If the surgeon finds one or more stones in the common bile duct(s), he
may remove them with a special scope (choledochoscope), may choose to have them removed
later through a second minimally invasive procedure (ERCP) or may convert to an open
operation in order to remove all the stones during the operation.
In a small number of patients the laparoscopic method cannot be performed. Factors that
may increase the possibility of choosing or converting to the "open" procedure may
include obesity, a history of prior abdominal surgery causing dense scar tissue,
inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon
either before or during the actual operation. When the surgeon feels that it is safest
to convert the laparoscopic procedure to an open one, this is not a complication, but
rather a sound surgical judgment. The decision to convert to an open procedure is
strictly based on patient safety.