Abstract: Background: Laparoscopic cholecystectomy is the gold standard procedure for symptomatic cholelithiasis and one of the most common surgical operations performed worldwide. However, laparoscopic approach to cholecystectomy may not be possible in every patient, thus conversion to open cholecystectomy is occasionally necessary to avoid or repair injury, delineate confusing anatomy or treat associated conditions. Patients and Method: A prospective study conducted in the Laparoscopy Unit- Department of General Surgery - Baquba Teaching Hospital – Diyala – Iraq, from January 2017 to December 2019. A total of 2749 patients of all age groups and both sexes who were found to have symptomatic gallstones were included in the study. Operative findings, causes of conversion and postoperative complications were recorded. Result: Out of the 2749 patients who were included in this study, successful laparoscopic cholecystectomy was completed in 2711 patients, while conversion to open procedure was required in 38 patients (1.38 %). Among those who were converted to open surgery, the most common cause of conversion was dense adhesions around the gallbladder representing 42.1 % of causes of conversion.The next common cause of conversion was obscure anatomy at Calot's triangle in 31.58 % patients. Instrument failure was responsible for 10.53 % of conversions. Massive bleeding that could not be controlled laparoscopically was the cause of conversion in 7.89 % of patients and visceral injury was the cause in 5.26 % while the least common cause of conversion was wide cystic duct in 2.63% which was difficult to clip laparoscopically. Conclusion: The risk of conversion to open surgery is always present and the decision about when to convert to laparotomy is an individual one, often subjective, made by the surgeon in the course of the procedure. The conversion rate in the present study was 1.38 % which is in the lower limit as compared to other studies, with causes similar to or approximating many national and international literatures.