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Predictors of Difficult Laparoscopic Cholecystectomy in Adults in a Nigerian Tertiary Hospital
Grace I Bassey1, Adebayo M Olugbami2, Freedman Ita-Lincoln3
1Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross-River State, Nigeria.
Background:
Laparoscopic cholecystectomy (LC) is the recommended treatment for benign gall bladder diseases. Difficult LC (DLC) is a recognised cause of prolonged surgery, the need for conversion to open procedure, and postoperative complications. The identification of the predictors of DLC preoperatively may contribute to improved preoperative planning and surgical outcome.
Aims And Objectives:
To determine the rate of DLC and predictors of DLC in adult patients at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife.
Materials And Methods:
We retrospectively analysed data from 129 case notes of patients who had LC over a 7-year period using STATA 18. Patients were grouped into normal LC and DLC. Bivariate analyses were conducted using appropriate statistical tests. Relevant factors were entered into a multivariable logistic regression model to identify independent predictors. Significance was set at P < 0.05.
Results:
Mean age was 45.8 ± 14.6 with a 5.8:1 female to male ratio. Nearly a quarter of the patients (n = 30, 23.3%) had a positive Murphy's sign. Overall mean surgery duration was 76.8 ± 21.9, with a 38.8% prevalence of DLC. Four LC were converted to open (n = 4, 3.1%). Positive predictors for DLC were age ≥60 years (adjusted odds ratio [AOR]: 3.34; 95% confidence interval [CI]: 1.02-11.02; P = 0.047) and a positive Murphy's sign (AOR: 3.63; 95% CI: 1.41-9.32; P = 0.07).
Conclusion:
The low rate of postoperative complications and conversion to open procedure despite the significant DLC rate indicates that with improved expertise/skills of the surgeon, safe LC is feasible and could become the main approach for cholecystectomy in Nigeria.