Predictive factors of surgical difficulty in laparoscopic cholecystectomy in a secondary hospital

TL;DR

This study identifies preoperative factors that predict surgical difficulty during laparoscopic cholecystectomy in a secondary hospital setting.

Contribution

The study provides new insights into specific preoperative predictors of surgical difficulty in non-tertiary hospitals.

Findings

41.4% of patients underwent difficult laparoscopic cholecystectomy.

Elevated alanine transaminase and gallbladder wall thickening were independent predictors of difficulty.

Difficult cases had longer operative times and higher complication rates.

Abstract

To identify preoperative factors predicting surgical difficulty in laparoscopic cholecystectomy at a secondary-level hospital.

A retrospective study included 697 adults undergoing laparoscopic cholecystectomy from January 2021 to June 2024. Demographic, clinical, laboratory, and ultrasound data, as well as intra- and postoperative outcomes, were collected. Operative difficulty was graded using Nassar’s scale (I–V). Logistic regression analyses identified predictors of difficult cholecystectomy (Nassar III–V).

Among the 697 patients (81.5% female; mean age 46.7 ± 14.0 years old; mean body mass index 29.2 ± 4.8 kg/m2), 41.4% were classified as difficult. Conversion to open surgery occurred in 1.1%. Difficult cases showed longer operative time (79.9 ± 39.3 versus 56.9 ± 19.6 minutes, p 0.01), greater use of intraoperative cholangiography (12.5 versus 3.7%, p 0.01), longer postoperative stay (p 0.01), and higher incidence of nausea/vomiting (15.2 versus 7.8%, p 0.01). Multivariate analysis identified elevated alanine transaminase (odds ratio = 2.89, 95% confidence interval 1.80–4.64, p 0.001) and gallbladder wall thickening 4 mm (odds ratio = 4.75, 95% confidence interval 2.85–7.91, p 0.001) as independent predictors.

Elevated alanine transaminase and gallbladder wall thickening are significant predictors of difficult laparoscopic cholecystectomy. Recognizing these factors may optimize surgical planning and enhance patient safety in non-tertiary hospitals.