Incidence of difficult laparoscopic cholecystectomy at a tertiary care hospital in eastern Nepal


Gall bladder Disease

How to Cite

Bhattarai, A., Adhikari, D., Yadav, D. K., Poudel, S., Parajuli, B., Koirala, A., & Yadav, R. P. (2023). Incidence of difficult laparoscopic cholecystectomy at a tertiary care hospital in eastern Nepal. Journal of Kathmandu Medical College, 12(1), 49–52. Retrieved from


Background: Laparoscopic cholecystectomy (LC) is the gold standard modality for the treatment of gall bladder diseases. Sometimes LC needs to be converted to open due to intraoperative complications. A few factors like age, body weight, comorbidities, ASA score, and surgeons’ experience will warn about the possible complications and need for conversion to open. Prior prediction of the difficulties will warn the surgeon to prepare accordingly. The patient’s family will also be counseled regarding it.

Objectives: To identify the possible factors for predicting difficult LC.

Methods: This was a descriptive cross-sectional study conducted in the general and laparoscopic surgery department at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Simple random sampling technique was utilised in this retrospective analysis. Data were taken from 2021 May to 2022 May after institutional ethical clearance. Descriptive statistics were assessed done using SPSS v.26.

Results: A total of 230 cases were included and analysed in the study. The incidence of difficult LC was 17.8%. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 1.3% of the cases. Intraoperative complications were not seen in 87.8% of the patients. The mean duration of hospital stay in difficult LC cases was five days.

Conclusion: Predicting difficult LC will not only warn surgeons to be prepared for the possible difficulties but will also help in counseling patients’ families regarding the intraoperative complications and the possible need for the conversion to open.



Singh K, Ohri A. Difficult laparoscopic cholecystectomy: A large series from north India. Indian J Surg 2006;68:205-08. [Full Text]

Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, et al. Laparoscopic cholecystectomy: Consensus conference-based guidelines. Langenbecks Arch Surg. 2015;400(4):429-53. [PubMed | Full Text | DOI]

National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy. Am J Surg. 1993;165(4):390-6. [PubMed | Full Text | DOI]

Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97(2):334–40. [PubMed | Full Text | DOI]

Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188(3):205-11. [PubMed | Full Text | DOI]

Giger UF, Michel JM, Opitz I, Inderbitzin DT, Kocher T, Krähenbühl L. Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: Analysis of 22,953 consecutive cases from the swiss association of laparoscopic and thoracoscopic surgery database. J Am Coll Surg. 2006;203(5):723-8. [PubMed | Full Text | DOI]

Ghadhban BR. Assessment of the difficulties in laparoscopic cholecystectomy among patients at Baghdad province. Ann Med Surg (Lond). 2019;41:16-9. [PubMed | Full Text | DOI]

Nidoni R, Vudachan T, Sasnur P, Baloorkar R, Sindgikar V, Narasangi B. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. J Clin Diagn Res. 2015;9(12):9-12. [PubMed | Full Text | DOI]

Kanakala V, Bowowski DW, Pellen MGC, Dronamraju SS, Woodcock SAA, Seymour K, et al. Risk factors in laparoscopic cholecystectomy: A multivariate analysis. International Journal of Surgery. 2011;9(4):318-23. [PubMed | Full Text | DOI]

Engel JM, Deitch EA, Sikkema W. Gall bladder wall thickness: Sonographic accuracy and relation to disease. AJR Am J Roentgenol. 1980;134(5):907-9. [PubMed | Full Text | DOI]

Amin A, Haider MI, Aamir IS, Khan MS, Choudry UK, Amir M, et al. Preoperative and operative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy in pakistan. Cureus. 2019;11(8). [PubMed | Full Text | DOI]

Hussien M, Appadurai IR, Delicata RJ, Carey PD. Laparoscopic cholecystectomy in the grossly obese: 4 years experience and review of literature. HPB. 2002;4(4):157-61. [PubMed | Full Text | DOI]

Chang WT, Lee KT, Huang MC, Chen JS, Chiang HC, Kuo KK, The impact of body mass index on laparoscopic cholecystectomy in Taiwan: an oriental experience. J Hepatobiliary Pancreat Surg. 2009;16(5):648-54. [PubMed | Full Text | DOI]

Ammori BJ, Vezakis A, Davides D, Martin IG, Larvin M, McMahon MJ. Laparoscopic cholecystectomy in morbidly obese patients. Surg Endosc. 2001 Nov;15(11):1336-9. [PubMed | Full Text | DOI]

Karim ST, Chakravarti S, Jain A, Patel G, Dey S. Difficult laparoscopic cholecystectomy predictors and its significance: This experience. J West Afr Coll Surg. 2022 Oct-Dec;12(4):56-63. [PubMed | Full Text | DOI]

Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS. 2002;6(1):59-63. [PubMed | Full Text]

Alhamid MA. Difficult laparoscopic cholecystectomy. Glob J Health Sci. 2019;11(9):102. [Full Text | DOI]