Deviation from Standard Anesthesia for Performing Laparoscopic Cholecystectomy: A Study of 2425 Cases

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallbladder diseases and is conventionally performed under general anesthesia (GA). However, spinal anesthesia (SA) is emerging as a viable alternative, especially in resource-limited settings. This study evaluates the feasibility, safety, and outcomes of LC under SA in a large cohort in Bangladesh. Methods: A prospective observational study was conducted on 2425 patients undergoing LC at a secondary-level hospital between March 2014 to March 2024. Patients aged 14–80 years with ASA physical status I–III were included. Key intraoperative and postoperative outcomes, including conversion rates, intraoperative complaints, and complications, were monitored. LC was performed using the standard four-port technique, with continuous monitoring of vital parameters. Results: The majority of patients were female (73.86%), with a mean age of 36.4 years. Conversion rates were low, with 0.78% requiring GA and 1.07% requiring open surgery. Shoulder pain (10.19%) and hypotension (7.13%) were the most common intraoperative complaints, both effectively managed. Postoperative complications were minimal, with urinary retention in 6.10% and spinal headache in 1.24%. Critical complications, such as bile duct injuries or significant bile leakage, were absent, highlighting the safety of SA for LC. Conclusion: LC under SA is a safe and efficient procedure with low complication rates, minimal conversions, and high procedural success. The findings emphasize SA as a cost-effective alternative to GA, suitable for resource-limited healthcare settings. This study reinforces the feasibility of integrating SA into standard surgical protocols for LC.