Early Complications in Acute versus Elective Cases of Laparoscopic Cholecystectomy in Tertiary Hospitals: A Comparative Study

Abstract

Objective: To correlate the operative findings of patients undergoing laparoscopic cholecystectomy, either acute or
elective, with surgical complications and conversion to open cholecystectomy.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital, Rawalpindi Pakistan,
from Jul 2021 to Mar 2022.

Methodology: Data from patients who underwent laparoscopic cholecystectomy was collected after gaining consent.
Patients were evaluated for the correlation of operative findings of acute and nonacute gallbladder cases with the
development of complications and conversion to open cholecystectomy.

Results: Out of 250 patients, 205 were non-acute cases, whereas 45 were acute. The most common intraoperative
complication was iatrogenic perforation of gallbladder 73(29.2%); more common in elective cases 49(19.6%) than in acute
cases 24(9.6%). Post-operative complications included sub-hepatic collections 3(1.2%) and port site infections 2(0.8%).
There were six overall conversions (2.4%), of which 3(1.2%) occurred in acute gallbladder cases and 3 in elective
gallbladder. Acute cases were significantly more likely to be converted to open operations (p=0.039). They were found to
have a significant association with gallstone spillage (p<0.001), iatrogenic perforation of the gallbladder (p<0.001), bile
leakage (p=0.018), and subhepatic collection (p=0.024).

Conclusion: The likelihood of surgical complications and conversion to open procedure can be accurately predicted by the
acute gallbladder status pre-operatively. It is thus important to consider these outcomes when commencing postoperative care