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0% vs 3.7% = .000, 30.9% vs 3.7% = .000, 1.8% vs 0.9% = .000, respectively). There was no significant difference in the open conversion rate or complications. HPS increase the difficulty of LC. Surgeons should be aware of their presence and should employ appropriate dissection strategies. Sharp or diathermy dissection should be avoided. Dislodging the stone into the gall bladder, stone removal, swab dissection, and cholangiography are useful measures to avoid ductal injury and reduce the conversion rate. HPS increase the difficulty of LC