TECHNICAL CHALLENGES IN PERFORMING LAPAROSCOPIC CHOLECYSTECTOMY
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i1.15251Keywords:
laparoscopic cholecystectomy, complications, risk factorsAbstract
SUMMARY. Laparoscopic cholecystectomy is the “gold standard” for the treatment of cholelithiasis, which is still associated with the risk of complications, in particular, damage to the bile ducts, bleeding and infections.
The aim – to analyze the technical difficulties that arise during laparoscopic cholecystectomy and develop strategies to overcome them.
Material and Methods. The medical records of 457 patients were analyzed. Technical difficulties were assessed based on intraoperative recordings and video recordings of operations and classified by type and degree of complexity. The results were evaluated by univariate and multivariate statistical analysis.
Results. A statistical analysis of risk factors for difficulties in accessing the abdominal cavity in acute cholecystitis was performed, odds ratios and confidence intervals for risk factors were calculated with a prediction of their degree, and risk stratification by the number of risk factors. A predictive model of abdominal access difficulties was created, and a comparative characterization of risk factors for different age groups was performed. The odds ratio for intraoperative complications during gallbladder removal was calculated.
Conclusions. Careful preoperative assessment of risk factors, such as a reduced gallbladder, previous acute cholecystitis, wall thickness >3mm, multiple stones, and obesity, allows the surgeon to plan the operation taking into account potential difficulties and take measures to minimize the risk of complications.
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