Objective: The research aims to identify preoperative factors that prolong surgical time in laparoscopic cholecystectomy (LC) before the procedure and to inform patient and surgeon selection decisions.
Material and Methods: Retrospective cross-sectional review of surgical records was conducted involving 400 LC cases. The patients who had LC are divided into two groups. An operative time of up to 90 minutes was classified as Group I, while a duration exceeding 90 minutes was categorized as Group II. The parameters compared for operative time of surgery are; gender, age, medical co-morbidity, single or multiple stones, previous surgery, gallbladder wall thickness, history of endoscopic retrograde cholangio pancreatography (ERCP) and endoscopic sphincterotomy (ES), laparoscopy performed by a resident or specialist, white blood cell count, and presence of adhesions in the sac site.
Results: When patients who had ERCP and/or ES prior to LC in Group I and Group II were compared, preoperative ERCP/ES was associated with prolonged operative time [odds ratio (OR): 2.48; 95% confidence interval (CI): 1.3-4.58; p=0.03]. Additionally, trainee-led procedures increased operative time (OR: 1.85; 95% CI: 1.18-2.88; p=0.02). As a result of statistical analyses, the surgeon’s experience (assistant or specialist) and preoperative ERCP or ES were identified as two key determinants contributing to the extended duration of LC.
Conclusion: Preoperative estimation of prolonged operative time before LC facilitates improved surgical, anesthetic, and staffing planning. Preoperative ERCP/ES, (p=0.03) and surgeon inexperience (p=0.05) independently prolonged the operative time (OR: 2.48 and 1.85, respectively). Prioritizing experienced surgeons for such cases optimizes OR scheduling.
Keywords: Laparoscopic cholecystectomy, operative time, ERCP, endoscopic sphincterotomy
