Comparative study of pre-peritoneal mesh repair versus onlay mesh repair of ventral hernias

Background: Laparoscopic cholecystectomy is the preferred procedure for gallbladder diseases, though anatomical variations pose challenges, increasing the risk of bile duct injuries and prolonged operative times. This study evaluates the incidence of vascular and biliary anomalies and their impact on surgical outcomes. Methods: A cross-sectional study was conducted at Kamineni institute of medical sciences from April 2023 to April 2024. Fifty patients undergoing laparoscopic cholecystectomy were selected through consecutive sampling. Intraoperative anomalies, surgical duration, and complications were recorded. Statistical analysis was performed using SPSS v25.0, with chi-square tests applied (p<0.05 considered significant). Ethical approval was obtained. Results: Anatomical anomalies were found in 26% of cases, with biliary anomalies (20%) more frequent than vascular (6%). Surgical duration exceeded two hours in 23% of patients with anomalies versus 5% in those without (p=0.025). Postoperative complications occurred in 8%, including bile leaks (4%) and minor bleeding (2%), predominantly in patients with anomalies. Conversion to open surgery was necessary in 6% due to difficult dissections or bleeding. Conclusions: Vascular and biliary anomalies significantly affect laparoscopic cholecystectomy, leading to prolonged surgery and increased complications. Preoperative imaging and intraoperative caution are crucial for identifying variations and minimizing risks. Strengthening surgical training and strict adherence to the critical view of safety (CVS) technique can enhance patient outcomes and reduce morbidity.