Risk factors for prolonged operative time in laparoscopic cholecystectomy

The most recent issue of the European Journal of Gastroenterology & Hepatology evaluates the impact of risk factors for prolonged operative time in laparoscopic cholecystectomy.

Laparoscopic cholecystectomy remains one of the most frequent surgical therapies for symptomatic gallstone disorders.

Prolonged operative time is frequently associated with increased complication rates.

Dr Marty Zdichavsky and colleagues identified the risk factors for prolonged operative times to minimize perioperative morbidity and optimize clinical management.

A total of 677 consecutive patients underwent laparoscopic cholecystectomy.

The exclusion criteria were conversion to an open procedure, intraoperative cholangiography, and liver cirrhosis.

5% of patients had undergone previous upper abdominal surgery

European Journal of Gastroenterology & Hepatology

The team analyzed data retrospectively with respect to age, sex, BMI, ASA score, previous abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography, acute cholecystitis, and surgeon’s experience.

A total of 596 patients, with a mean age of 52 years, were analyzed.

In all, 29% of the patients were obese, 11% had ASA III.

The researchers found that 5% of patients had undergone previous upper abdominal surgery.

Overall, the team found that 105 out of 596 patients had an acute cholecystitis.

The team noted that residents of general surgery performed 58% of all operations.

The research team observed that the median operative time was 80 minutes.

The researchers found no statistical significance between intraoperative and postoperative complications by surgeon’s experience.

Statistically, independent preoperative predictors for prolonged operative time as identified through multivariate analysis were acute cholecystitis, obesity, previous upper abdominal surgery, male sex, and low degree of surgical expertise.

Dr Zdichavsky's team concludes, "The risk for prolonged operative times in laparoscopic cholecystectomy can be assessed on the basis of patients’ characteristics."

"Assessment of these factors not only helps to optimize the individual outcome for each patient but also improves the decision process toward operative training for junior surgeons."