Per-operative Evaluation of Patient Related Difficulties of Laparoscopic Cholecystectomy

Open Access

Abstract

Background: Gallstone disease is a common cause of morbidity, with an estimated prevalence of 5-22% in the general population. In settings where delayed presentation is frequent due to limited healthcare access and low patient awareness, laparoscopic cholecystectomy can be technically challenging because of difficulties with abdominal access, pneumoperitoneum creation, dissection of the gallbladder, and specimen retrieval. Methods & Materials: This descriptive study was performed in the Chittagong Medical College Hospital General Surgery wards from August 2016 to January 2017. In this study, 100 patients who underwent laparoscopic cholecystectomy during the study period were included by purposive consecutive sampling meeting the inclusion criteria. Data were analyzed using chi-square and Student t-tests as appropriate. Results: Among the 100 patients who underwent laparoscopic cholecystectomy, 12 cases were categorized as difficult, primarily due to prolonged operative time exceeding 50 minutes, although all were completed laparoscopically. The average operative duration was 36.53 minutes. Difficulties were more frequent among females (66.7%) and patients aged 40-60 years. Significant predictors of operative difficulty included intra-abdominal adhesion of the gallbladder to the gut (p<0.001, OR=29.40), short and wide cystic duct (p=0.008, OR=5.79), and adhesion at Calot's triangle (p=0.041, OR=3.90). Two cases required conversion to open surgery due to unclear anatomy and risk of common bile duct injury. Conclusion: Laparoscopic cholecystectomy is a common operation, but sometimes it becomes difficult due to several factors. Adhesion of GB with gut, short, wide cystic duct, and adhesion at Calot's triangle are challenging to operate upon and increase the operating time.