Safety of laparoscopic cholecystectomy after prior upper abdominal surgery

Prior upper abdominal surgery (PUAS) has traditionally been considered a challenging setting for laparoscopic cholecystectomy (LC) due to adhesions and distorted anatomy. However, its impact on operative safety remains uncertain. This study aimed to evaluate the safety of LC for symptomatic gallstone disease in patients with prior abdominal surgery (PAS), with particular emphasis on PUAS.

A retrospective observational study including consecutive patients undergoing LC between July 2024 and December 2025 was conducted. The primary exposure variable was PUAS. The primary outcome was 30-day postoperative morbidity. Secondary outcomes included intraoperative adverse events (IAE), conversion to open surgery, bile leak, bile duct injury, mortality, length of stay, and feasibility of intraoperative cholangiography (IOC).

A total of 408 patients were included; 148 (36.3%) had PAS and 32 (7.8%) had PUAS. PUAS was associated with higher intraoperative difficulty and increased need for adhesiolysis. Postoperative morbidity was higher in the PUAS group (12.5% vs .3.7%, P=0.04). However, no differences were observed in IAE, conversion, bile duct injury, bile leak, or mortality. IAE were infrequent (3.9%) and mostly minor, with only one event in the PUAS group. IOC was successfully performed in >96% of cases regardless of prior surgery.

PUAS is associated with increased operative difficulty and higher postoperative morbidity but does not adversely impact major outcomes. LC with routine IOC and single-stage management of choledocholithiasis remains feasible and safe in these patients, although increased technical complexity should be anticipated.