Evaluation of Clinicopathological and Radiological Parameters in Predicting the Difficulty of Laparoscopic Cholecystectomy

Abstract

Background: Difficult laparoscopic cholecystectomy carries prolonged operative time, conversion, and morbidity; preoperative identification of high-risk patients aids planning and counselling.

Aims/Objectives: To determine the clinical, pathological, and radiological parameters that predict difficult laparoscopic cholecystectomy and to identify independent predictors.

Methodology: This prospective observational study enrolled 100 patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis. Preoperative clinical, biochemical, and ultrasonographic parameters were recorded and correlated with an operationally defined difficult procedure. Associations were assessed using the chi-square test, Fisher exact test, and independent t-test, followed by multivariable logistic regression.

Results: A difficult procedure occurred in 26 (26.0%) patients. Significant predictors were gallbladder wall thickening greater than 3 millimetres (13/26, 50.0% versus 8/74, 10.8%; odds ratio 7.82; p<0.001), positive Murphy sign (11/26, 42.3% versus 2/74, 2.7%; p<0.001), prior hospitalisation (12/26, 46.2% versus 4/74, 5.4%; p<0.001), two or more previous attacks (16/26, 61.5% versus 16/74, 21.6%; p<0.001), raised alkaline phosphatase (10/26, 38.5%; p=0.002), and leucocytosis (11/26, 42.3%; p=0.009). Wall thickening remained an independent predictor (adjusted odds ratio 4.62; p=0.021). Conversion to open surgery was required in 2 (2.0%) patients.

Conclusions: Gallbladder wall thickening, inflammatory clinical signs, and recurrent biliary disease reliably predict operative difficulty and permit preoperative risk stratification.