Cross Sectional Evaluation of Pre-operative Predictive Factors for Difficult Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.36283/ziun-pjmd14-3/005Keywords:
Laparoscopic cholecystectomy, Preoperative Period, Risk Factors, Cholecystitis.Abstract
Background: Laparoscopic gallbladder removals are performed in several cases, though complications can necessitate the conversion to open surgery. The identification of risk factors for difficult laparoscopic cholecystectomy (LC) enhances surgical planning and patient safety. The objective of the study was to evaluate the demographic, clinical, and imaging parameters in patients with cholecystitis that may predict the difficulty of LC.
Methods: This cross-sectional study was conducted in Unit I of the Department of Surgery at Fatima Memorial Hospital, Lahore, between March and May 2025, under ethical approval (FMH-IRB-1637). A total of 72 patients diagnosed with cholecystitis aged from 16 to 65 years of age and underwent LC for cholecystitis were included using a consecutive sampling technique. Demographic, clinical, and imaging information was collected using a standardized proforma. The dates of intraoperative findings, duration of operation, conversion to open surgery, and postoperative results were noted. Chi-square and t-tests were used to perform statistical analysis with a significance level of p < 0.05.
Results: Difficult LC was encountered in 24 (of the 72 patients. Factors with the largest predictive effect were patients who were ≥50 (18 (75.0%)), had obesity (14 (58.3%)), a past abdominal operation (11 (45.8%)), had experienced ERCP (6 (25.0%)), and presented with thickening of the gallbladder (17 (70.8%)) along with dilation of the CBD (6 (25.0%). Cases that were more difficult had surgeries that lasted longer (mean 95.3 ± 20.1 min compared to 54.7 ± 15.6 min; p<0.001), involved more open conversions (6 (25.0 %) versus 0 (0%); p<0.001), and had more post-operative complications.
Conclusion: Many pre-operative factors, such as age, being obese, having previous surgery, and unusual imaging results, give hints that a patient will suffer from difficult LC. By identifying these signs, surgeons can prepare patients for counseling, sort risks, and make decisions.
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