Background : Laparoscopic cholecystectomy (LC) is the gold standard for surgical treatment of cholecystitis with gallstones. To date, there are no studies in the Philippines regarding prediction of a potentially “difficult” laparoscopic cholecystectomy. This study identifies from retrospective data which factors predict difficult laparoscopic cholecystectomy.

Methods : Retrospective study at The Medical City, Philippines over a period of five years (2017-2021). Patients having symptomatic cholelithiasis above 18 years of age were included. The following pre-operative parameters were evaluated in the study: clinical assessment, biochemical and radiologic findings. Data were analyzed using Stata 14.0 with a 0.05 level of significance after cross-tabulating the data.

Results : A total of 2,872 laparoscopic cholecystectomies were performed from January 2017 to December 2021. And 2,698 patient records were included in the analysis based on the inclusion criteria mentioned. The authors did not include incidental or prophylactic cholecystectomies, those who had planned open cholecystectomies, laparoscopic cholecystectomy using 3-port or single port technique, patients with acalculous cholecystitis and those with incomplete data record. Among the 2,698 cases, 593 or 21.98% were difficult laparoscopic cholecystectomy cases. Based on the multivariate analysis, after adjusting for other variables, the study showed the following factors were strongly associated with difficult laparoscopic cholecystectomy such as being male, per unit increase in body mass index (BMI), having a history of jaundice, having a history of fever, history of laparoscopic abdominal surgery and having right upper quadrant tenderness. Radiologic factors also strongly associated with difficult laparoscopic cholecystectomy are thickened gallbladder wall, dilated common bile duct, impacted gallbladder stone, pericholecystic fluid, cirrhosis, and per centimeter increase in size of the largest stone.

Conclusions : The significant preoperative predictive factors mentioned in the study would help anticipate the difficulty of laparoscopic cholecystectomy and therefore forewarned the surgical team and help prepare in advance for a more complex surgery.