WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Haitham Khoudyer Deamah, Dr. Zainab Omar Ahmed

ABSTRACT

Background: Laparoscopic cholecystectomy is the standard surgical treatment for symptomatic gallstone disease; however, some cases are technically difficult because of inflammation, adhesions, distorted Calot’s triangle anatomy, thickened gallbladder wall, or impacted stones. Preoperative identification of difficult cases is important for surgical planning and patient safety. Objectives: To assess the clinical and ultrasonographic predictors of difficult laparoscopic cholecystectomy among patients with gallstone disease in Mosul City. Methods: This prospective observational study was conducted at the Department of General Surgery, Mosul General Hospital, Mosul City, Iraq, from the 1st of February 2025 to the 1st of March 2026. The study included 57 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy. Clinical variables, laboratory findings, and preoperative ultrasound findings were recorded. Difficult laparoscopic cholecystectomy was defined by the presence of one or more intraoperative indicators, including operative time more than 60 minutes, dense adhesions, difficult Calot’s triangle dissection, gallbladder perforation, significant bleeding, fundus-first approach, subtotal cholecystectomy, or conversion to open surgery. Results: Difficult laparoscopic cholecystectomy was reported in 22 patients (38.6%), while 35 patients (61.4%) had non-difficult procedures. Significant clinical predictors included age ≥50 years, male sex, obesity, previous acute cholecystitis, fever, right upper quadrant tenderness, and leukocytosis. Significant ultrasound predictors included gallbladder wall thickness >3 mm, contracted gallbladder, impacted stone at the gallbladder neck or Hartmann’s pouch, and pericholecystic fluid. On multivariate analysis, previous acute cholecystitis, leukocytosis, gallbladder wall thickness >3 mm, and impacted stone were independent predictors of difficult laparoscopic cholecystectomy. Conversion to open surgery occurred in 4 patients (7.0%), all within the difficult group. Conclusions: Difficult laparoscopic cholecystectomy was relatively common among patients with gallstone disease in this study. Previous acute cholecystitis, leukocytosis, thickened gallbladder wall, and impacted stone at the gallbladder neck or Hartmann’s pouch were the strongest predictors. Combined clinical and ultrasonographic assessment is recommended before surgery to improve operative planning, patient counselling, and surgical safety.

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