Published: 2019-08-28

A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy

Mohhamad Sadik Akhtar, Parwez Alam, Yasir Alvi, Syed Amjad Ali Rizvi, Mohhmad Habib Raza


Background: With widespread use of laparoscopic cholecystectomy and its applicability in many difficult situation, the chances of complication and difficulty during surgery have increased. This study was done to determine the factors which could preoperatively predict difficulty undergoing laparoscopic cholecystectomy.

Methods: The data were obtained from the patients admitted to in wards of General Surgery, JN Medical Collage, Aligarh Muslim University, and Aligarh, India undergoing laparoscopic cholecystectomy. The difficult laparoscopic cholecystectomy was defined as procedures exceeded 70 minutes in duration or those which were converted to open procedure. Dependent variable included demographic factors, clinical and sonographic findings. P value was kept at 0.05.

Results: During the study duration, 200 patients were included in the study undergoing for the laparoscopic cholecystectomy and out of this 85 had difficult outcome procedure. High BMI, hypertension, previous upper abdomen surgery, deranges AST and serum creatinine along sonographic findings of gall balder wall thickening and pericholecytsic edema were found to be significantly associated with difficult LC.

Conclusions: This study demonstrates that presence of various factors can predict the difficult outcome of laparoscopic cholecystectomy. This can help in minimizing the complication and council the patients regarding difficult procedure and need for conversion to open cholecystectomy, especially relevant for funds-limited settings like India.


Gall bladder, Laparoscopic cholecystectomy, Calot’s triangle

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Edward H, Livingston Robert V, Rege. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188:205–11.

Alponat A, Kum CK, Koh BC, Rajnakova A, and Goh PMY, Predictive Factors for Conversion of Laparoscopic Cholecystectomy. World J Surg. 1997;21(6):629–33.

Atmaram DC. Predictive Factors for Conversion of Laparoscopic Cholecystectomy Indian J Surg. 2011;73(6):423-6.

Vivek MAKM, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg. 2014;10(2):62–7.

Farzana M, Roger CG, Sumera B, Mehmood AK, Amber B, Saeed Q, et al. Conversion of laparoscopic to open cholecystectomy, is gender a predictor? Pak J Surg. 2014;30(4):290-5.

Nunnally JC, Bernstein IH. Psychometric theory. 3rd edition. New York: Tata McGraw-Hill Ed; 1994.

Sahu SK, Agrawal A, Sachan PK. Intraoperative Difficulties In Laparoscopic Cholecystectomy. Jurnalul de Chirurgie. 2013;9:149–155.

Supe A, Nachnani J, Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Ind J Gastro. 2005;24:16–18.

Gerald MF, Jeffrey SB, Harvey HS, Lawrence J, David C, Jacob G, et al. Factors Determining Conversion to Laparotomy in Patients Undergoing Laparoscopic Cholecystectomy. American J Surg. 1994;167.

Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc. 2001;15:965-8.

Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method, Indian J Surg. 2009;71(4):198–201.

Yamamoto T, Komori J, Morimoto T, Kobayashi H, Kaihara S, Hosotani R. Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours after Hospital Admission. Int Surg. 2017;102:145–50.

Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O. Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery. A New Predictive Statistical Model. J Laparoendoscopic Adv Surg Techniq. 2016;26:9.

Gupta N et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013;11(9):1002–6.

Zhang WJ, li MI, Wu GZ, Luo K, Dong Z. Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy. J Surg. 2008;78:973–6.

Wevers KP, Westreenen HL, Patijn GA. Laparoscopic Cholecystectomy in Acute Cholecystitis: C-Reactive Protein Level Combined With Age Predicts Conversion. Surg Laparosc Endosc Percutan Tech. 2013;23:163–6.

Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. J Soc Laparoendosc Surg. 2002;6(1):59–63.

Stanisic V, Stojanovic MK, Babic V. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. European Rev Med Pharmacol Sci. 2014;18:1204-11.