Operative difficulty of laparoscopic cholecystectomy in obese patients - a THQ hospital experience

Abstract Objective: To determine the factors responsible for operative difficulty of laparoscopic cholecystectomy in obese patients at a THQ hospital Lahore, was the objective of this study. Methods and Material: This retrospective study was conducted at department of General surgery, Government THQ Hospital Sabzazar, Lahore from May 2021 to October 2023 and included 189 obese patients with gall bladder disease. All Patient underwent laparoscopic cholecystectomy by single consultant surgeon. Patient`s demographics and factors responsible for operative difficulty were recorded. Results: Mean age of obese patients was 48.63±10.72 years. There were 41 (21.69%) male and 148 (78.30%) female patients. Mean BMI was 37.89±1.29Kg/m2. Out of 189 obese patients, 72 (38.09%) patients were diabetic and 127 (67.19%) patients were hypertensive. Indication of surgery was biliary colic in 183 (96.82%) patients and gall bladder polyp in 6 (3.17%) patients. Mean operative time and mean hospital stay were 112.03±6.89 minutes and 3.01±1.27 days, respectively. Factors responsible for operative difficulty in obese patients were difficult umbilical access in 97 (51.32%) patients, insufficient gall bladder retraction in 73 (38.62%), visceral hindrance in getting adequate calot’s triangle exposure in 128 (67.72%), problematic calot’s triangle dissection in 149 (78.83%), gall bladder perforation in 7 (3.70%), troublesome gall bladder bed dissection in 37 (19.57%), hemorrhage in 64 (33.86%), biliary injury in 0 (0.00%) and difficult port closure in 119 (62.96%) patients during laparoscopic cholecystectomy. Conclusions: Perplexity in Calot’s triangle dissection is the quotidian factor responsible for operative difficulty of laparoscopic cholecystectomy in obese patients to implement safe cholecystectomy. Key-words: Laparoscopic cholecystectomy; obese; operative difficulty