Assessment of preoperative factors in relation with difficulty of laparoscopic cholecystectomy

Nayyef, Ahmed Abdulsattar; Alkawaz, Hayder Sabah

doi:10.52573/ipmj.2025.151303

	Assessment of preoperative factors in relation with difficulty of laparoscopic cholecystectomy
Iraqi Postgraduate Medical Journal
Article 15, Volume 24, Issue 3, July 2025, Pages 419-426 PDF (1.21 M)
Document Type: Research Paper
DOI: 10.52573/ipmj.2025.151303
Authors
Ahmed Abdulsattar Nayyef^* ¹; Hayder Sabah Alkawaz²
¹Ministry of health
²Department of Surgery, Al-Yarmouk Teaching Hospital
Abstract
Introduction Laparoscopic cholecystectomy is the gold standard for treatment of gallbladder diseases It is relatively a simple and quick procedure, but it can be difficult, and needs special instruments and an experienced surgeon. Moreover, in specific situations, conversion from laparoscopic to open approach is still required. However, identifying the preoperative patient-related factors, and anticipating the need to convert from laparoscopic cholecystectomy to open surgery can help identifying high-risk patients and redefine the surgical strategy needed Aim: Assessing laparoscopic cholecystectomies, by identifying the preoperative factors that predict the difficulty of laparoscopic cholecystectomy. Patients and Method A prospective cross-sectional study conducted in Al Yarmouk Teaching Hospital for a period of one year. Patients whom were admitted for laparoscopic cholecystectomy were approached. Data were collected and analyzed. Continuous variables were presented as Mean ± Standard Deviation (SD) and categorical variables were presented as frequency and percentage. Chi-square and Fischer exact tests were applied to illustrate the significance of the association between preoperative factors and the difficulty level of laparoscopic cholecystectomy. In all statistical analyses, a P value of ≤0.05 was considered significant. Results The average time needed for laparoscopic cholecystectomy was 58.9±10.0 minutes. The average time needed for port installation (porting time) was 8.5± 2.1 minutes. Difficult procedure was reported in 100 (89.3%), of them 99 (88.4%) patients were classified as having moderate difficulty, and only one case was considered as very difficult and was converted to open procedure. The current study showed a significant association between the difficulty level of laparoscopic cholecystectomy and older age, male gender, and high BMI. Conclusion and recommendations Identifying the pre-operative factors that are associated with difficult laparoscopic cholecystectomy is very helpful to lower complication incident rate and increase readiness and preparedness. Further reviews is needed to establish an Iraqi score system for predicting difficult laparoscopic cholecystectomy.
Keywords
laparoscopy; laparoscopic cholecystectomy; difficulty; preoperative factors

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