ArticleActa cirurgica brasileira2026
Predictive factors of surgical difficulty in laparoscopic cholecystectomy in a secondary hospital.
Article in Acta cirurgica brasileira, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo identify preoperative factors predicting surgical difficulty in laparoscopic cholecystectomy at a secondary-level hospital.
methodsA retrospective study included 697 adults undergoing laparoscopic cholecystectomy from January 2021 to June 2024. Demographic, clinical, laboratory, and ultrasound data, as well as intra- and postoperative outcomes, were collected. Operative difficulty was graded using Nassar's scale (I-V). Logistic regression analyses identified predictors of difficult cholecystectomy (Nassar III-V).
resultsAmong the 697 patients (81.5% female; mean age 46.7 ± 14.0 years old; mean body mass index 29.2 ± 4.8 kg/m2), 41.4% were classified as difficult. Conversion to open surgery occurred in 1.1%. Difficult cases showed longer operative time (79.9 ± 39.3 versus 56.9 ± 19.6 minutes, p 0.01), greater use of intraoperative cholangiography (12.5 versus 3.7%, p 0.01), longer postoperative stay (p 0.01), and higher incidence of nausea/vomiting (15.2 versus 7.8%, p 0.01). Multivariate analysis identified elevated alanine transaminase (odds ratio = 2.89, 95% confidence interval 1.80-4.64, p 0.001) and gallbladder wall thickening 4 mm (odds ratio = 4.75, 95% confidence interval 2.85-7.91, p 0.001) as independent predictors.
conclusionElevated alanine transaminase and gallbladder wall thickening are significant predictors of difficult laparoscopic cholecystectomy. Recognizing these factors may optimize surgical planning and enhance patient safety in non-tertiary hospitals.
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