Prediction of difficult laparoscopic cholecystectomy: An observational study

Laparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Thus, we aimed to identify predictors for difficult LC.

A retrospective cross-sectional review of surgical records was done. Patients who underwent laparoscopic cholecystectomy on an elective basis from July 2017 to June 2021 were included in the study. We divided our patients into two groups based on operative findings of difficult LC; difficult LC group and non-difficult LC group. We compared patient's demographics, predictors, and perioperative details and analyzed the data.

A total of 338 patients (82 males) with a median age of 47 years were studied. Total difficult LC was found in 52 patients (15.4%). The overall conversion rate was 8.9%. Logistic multivariable regression analysis revealed that; male gender (odds ratio (OR); 0.171, confidence interval (CI),(0.043-0.675), P; 0.012), past history of acute cholecystitis (OR; 0.038, CI; (0.005-0.309), P; 0.002), gall bladder wall thickness (≥4-5 mm) (OR; 0.074, CI; (0.008-0.666), P; 0.020), fibrotic gallbladder (OR; 166.6, CI; (7.946-3492), P; 0.001), and adhesion at Calot's triangle (OR; 0.021, CI (0.001-0.311), P; 0.005) were independent predictors of difficult LC.

Gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4-5 mm), fibrotic gallbladder, and adhesion at Calot's triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.