Prevalence and Predictors of Difficult Laparoscopic Cholecystectomy in a Tertiary Care Hospital: A Cross-Sectional Study

Abstract

Objective: To identify the prevalence and predictors of hard laparoscopic cholecystectomy in a tertiary care hospital at Pakistan.

Methods: It is a three-month cross sectional observational study that involved 150 adult patients who had laparoscopic cholecystectomy. The patients with gallbladder malignancy, severe coagulopathy, primary open cholecystectomy, or any incomplete intraoperative information were excluded. Information was gathered in a prospective manner through a structured exercise that is a questionnaire. Operative criteria used to define the difficulty LC were that operative time exceeded 90 minutes, that the surgery was converted to an open surgery, significant hemorrhage (>100 mL), extreme adhesions, poor visibility of Calot triple anatomy, or subtotal cholecystectomy. Univariate and multivariate logistic regression in SPSS was used as a statistical analysis.

Results: The rate of tough LC was 28 percent. The independent predictors were the gallbladder wall greater than 4 mm thick (OR 3.1; 95% CI: 1.530 6.22; p=0.002), previous history of acute cholecystitis (OR 2.7; 95% CI: 1.310 5.88; p= 0.006), BMI greater than 30 kg/m 2 (OR 2.2; 95% CI: 1.049 In 12.7 percent of patients, postoperative events were related to complications; the wound infection and bile leak are most often identified.

Conclusion: Difficult LC was present in above quarter of the cases. Wall thickness of the gallbladder greater than 4 mm, a history of prior acute cholecystitis, obesity and harsh adhesions were powerful independent predictors. With the identification of such risk factors antecedent to surgery, it is possible to prepare surgery and educate the patient to better perioperative outcomes.