# 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.

## Key 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.