Background: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallstone disease. However, conversion to open cholecystectomy (OC) may be required in certain cases due to intraoperative complications. This study aimed to evaluate the conversion rate and identify factors influencing the need for conversion from LC to OC. Methodology: An observational study was conducted at Rajshree Medical Research Institute & Hospital Bareillyfrom December 2022 to July 2024, involving 196 patients undergoing elective LC for symptomatic cholelithiasis. Excluded were patients with acute cholecystitis, gallbladder cancer, or other contraindications. Preoperative evaluations included clinical and imaging assessments. Statistical analysis was performed using SPSS v21.0. Results: The overall conversion rate was 8%, with higher rates in males (15.4%) and older patients. Significant predictors of conversion included acute cholecystitis, pericholecystic fluid, and thickened gallbladder walls. The most common reason for conversion was adhesions at Calot’s triangle (62.5%). Postoperative recovery was faster in LC patients, who had shorter hospital stays and fewer complications. Conclusion: Conversion to OC is influenced by factors such as age, male gender, acute cholecystitis, and gallbladder wall thickness. LC remains the preferred approach, with OC as a backup when necessary. Preoperative evaluation and informed consent are essential for managing potential conversions.