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Background <p>Laparoscopic cholecystectomy, one of the most performed surgeries, is often challenged by the unknown condition of the gallbladder before surgery, making the likelihood of encountering difficulties inevitable. This study aimed to prospectively identify risk factors for difficult cholecystectomy by analyzing preoperative and intraoperative data, and to evaluate the predictive value for identifying patients at risk of difficult cholecystectomy.</p> Methods <p>This prospective cohort study included 638 patients undergoing laparoscopic cholecystectomy without acute intervention between May 2018 and May 2020. Two groups were formed based on the Parkland Grading System, categorizing patients into “easy” and “difficult” laparoscopic cholecystectomy groups, and considering demographic data, as well as preoperative and intraoperative findings.</p> Results <p>The difficult cholecystectomy group comprised patients with a Parkland Grading System score of 3–5. This group experienced significantly more intraoperative challenges than the easy group, especially among male patients (p &lt; 0.001), those with ASA scores of 3–4 (p = 0.002), and those with histories of abdominal surgery (p = 0.0046), ERCP (p &lt; 0.001), or severe gallbladder-related pain (p &lt; 0.001). Gallbladder wall thickness ≥ 4 mm (p &lt; 0.001) and presence of multiple gallstones (p = 0.008) were also associated with increased difficulty.</p> Conclusions <p>The study demonstrated that male patients have a 2.19-fold increased risk of difficult surgery, while those with a history of severe gallbladder-related pain have a 5.02-fold increased risk. Furthermore, the conversion rate from laparoscopic to open surgery was 15.68 times higher in the difficult group. These predictive factors are clinically important as they may help prevent undesirable complications.</p>

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Unraveling the Complexity of Difficult Cholecystectomies: A Prospective Cohort Analysis of Preoperative Predictors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月10日

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  • Doğuş Durmuş,
  • Rahman Şenocak,
  • Ali Kağan Coşkun

摘要

Background

Laparoscopic cholecystectomy, one of the most performed surgeries, is often challenged by the unknown condition of the gallbladder before surgery, making the likelihood of encountering difficulties inevitable. This study aimed to prospectively identify risk factors for difficult cholecystectomy by analyzing preoperative and intraoperative data, and to evaluate the predictive value for identifying patients at risk of difficult cholecystectomy.

Methods

This prospective cohort study included 638 patients undergoing laparoscopic cholecystectomy without acute intervention between May 2018 and May 2020. Two groups were formed based on the Parkland Grading System, categorizing patients into “easy” and “difficult” laparoscopic cholecystectomy groups, and considering demographic data, as well as preoperative and intraoperative findings.

Results

The difficult cholecystectomy group comprised patients with a Parkland Grading System score of 3–5. This group experienced significantly more intraoperative challenges than the easy group, especially among male patients (p < 0.001), those with ASA scores of 3–4 (p = 0.002), and those with histories of abdominal surgery (p = 0.0046), ERCP (p < 0.001), or severe gallbladder-related pain (p < 0.001). Gallbladder wall thickness ≥ 4 mm (p < 0.001) and presence of multiple gallstones (p = 0.008) were also associated with increased difficulty.

Conclusions

The study demonstrated that male patients have a 2.19-fold increased risk of difficult surgery, while those with a history of severe gallbladder-related pain have a 5.02-fold increased risk. Furthermore, the conversion rate from laparoscopic to open surgery was 15.68 times higher in the difficult group. These predictive factors are clinically important as they may help prevent undesirable complications.