Gender as a Predictive Pre-Operative Factor for Difficult Laparoscopic Cholecystectomy

Abstract

Objective: The aim is to establish the rate of difficult laparoscopic cholecystectomy (DLC) and to evaluate the correlation between difficult laparoscopic cholecystectomy and demographic, clinical, and intraoperative variables.

Methodology: The cross-sectional analytical study was carried out in the Department of general surgeries, Jinnah international hospital, Abbottabad between April and December 2025. One hundred and forty patients aged 18 to 90 years undergoing elective laparoscopic cholecystectomy were enrolled consecutively. Demographic data, comorbidities, and preoperative diagnosis, intraoperative diagnoses, and postoperative outcomes were collected. DLC was characterized by the existence of thick adhesions, severe inflammation, or abnormal anatomy of the biliary in a way that made the dissection of the gallbladder difficult. The analysis of data was performed with SPSS v26. Continuous variables were presented as the mean standard deviation; categorical variables in terms of frequencies and percentages. Chi-square tests were used to evaluate the associations with the DLC, considering the p-value <0.05 as significant.

Results: The mean age of the study sample was 44.6 ± 12.3 years consisting of 65.7% female patients. Difficult Laparoscopic Cholecystectomy occurred in 58 (41.4%) patients. DLC was more likely in male patients in comparison with female (54.2% vs. 34.8%, p-value = 0.028). DLC was significantly associated with intraoperative adhesions (67.9% vs. 23.8%, p-value < 0.001). The DLC rates were associated with older age and with acute cholecystitis but not statistically significant.

Conclusion: When gallbladder surgery is elective, a difficult laparoscopic cholecystectomy is prevalent. Two important factors include intraoperative adhesions and male gender. Surgical results, operative planning, and preoperative risk assessment can all be improved by raising awareness of these aspects.