Intraoperative Findings and Difficulties Encountered During Laparoscopic Cholecystectomy: An Observational Study

Background:
Laparoscopic cholecystectomy is the standard intervention for
symptomatic gallstone disease; however, intraoperative challenges can
prolong surgery or increase complications.
Objective:
This study evaluated the frequency and determinants of operative
difficulties.
Methods:
A prospective observational study was conducted among 67 patients
undergoing laparoscopic cholecystectomy at Green Life Medical
College Hospital between January 2022 and December 2023. Patients
with cirrhosis, malignancy, prior upper abdominal surgery, or
coagulation disorders were excluded. Intraoperative variables,
including gallbladder wall thickness, adhesions, anatomical variations,
and dissection complexity, were documented.
Results:
Standard procedures were completed in 76.1% of cases, whereas
14.9% were classified as difficult. Distended or congested gallbladder
(32.8%) and omental wrapping (20.9%) were common findings. Thick
gallbladder wall ≥3 mm, dense adhesions, and difficult Calot’s triangle
dissection independently predicted operative difficulty.
Conclusion:
Preoperative identification of gallbladder wall thickening, adhesions,
and complex Calot’s triangle anatomy may help anticipate a
challenging laparoscopic cholecystectomy.