69 Laparoscopic Cholecystectomy Today: A Harder Operation Than It Used to Be?

Abstract Aim Laparoscopic cholecystectomy (LC) is recognized for its diverse complexity between cases, which profoundly influences perioperative progression and patient outcomes. It is notoriously difficult to accurately predict surgical complexity pre-operatively. We hypothesise that the difficulty of cholecystectomy has increased in recent years. Method A retrospective review was conducted over a 34-month period, including all consecutive laparoscopic cholecystectomies performed by two consultant biliary surgeons. Operative difficulty was prospectively graded using the Nassar Cholecystectomy Scale. Results were compared to published data from the CholeS study to assess changes in case complexity over time. Results 319 laparoscopic patients were identified. The table below compares our results with Choles study.CholeS Study(N=8,755)Our Study(N=319)P valueEmergency cases1,391 (15.9%)98 (31.0%)<0.001Nassar Cholecystectomy Scale:13,524 (40.6%)34 (10.7%)<0.00122,608 (30.0%)103 (32.3%)0.39731,769 (20.4%)69 (21.6%)0.5344/5779 (9%)113 (35.4%)<0.001Intraopertaive cholangiogram1,052 (12%)230 (72.1%)<0.001Bile duct exploration256 (2.9%)92 (28.8%)<0.00130-day readmission618 (7.1%)15 (4.7%)0.105Complications937 (10.7%)20 (6.3%)0.011 Conclusions Our findings demonstrate a clear increase in both the proportion of emergency laparoscopic cholecystectomies and operative difficulty, as reflected by higher Nassar grades, compared to the CholeS study. This trend likely reflects broader systemic pressures, including delayed access to theatre, evolving patient comorbidities, and resource constraints. Prioritising index admission cholecystectomy is essential to reduce readmissions and mitigate progression to more complex, higher-risk procedures.