DEMOGRAPHIC AND CLINICAL CHARACTERISTICS ASSOCIATED WITH DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A META-ANALYSIS OF OBSERVATIONAL STUDIES pguerreros@unal.edu.co

 

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS ASSOCIATED WITH DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A META-ANALYSIS OF OBSERVATIONAL STUDIES

3

Colombia

Oral or Poster

Laparoscopic cholecystectomy is the procedure of choice for the surgical management of biliary pathology. However, certain patient groups present greater technical challenges. As a result, various studies have attempted to identify risk factors associated with difficult cholecystectomy, but findings remain heterogeneous. Therefore, a synthesis of existing evidence is necessary to determine the preoperative factors associated with difficult laparoscopic cholecystectomy.

A meta-analysis of observational studies was conducted based on the PRISMA model, including articles published between 2014 and 2024 in the PubMED, LILACS, Science Direct, Scielo, and Cochrane Central Register databases. The protocol was registered on the Prospero platform with code 482694. After the screening and selection phase, 23 articles were included, covering a total of 10,227 individuals.

Preoperative demographic and clinical variables significantly associated with difficult cholecystectomy were male sex (OR 0.45 [95%CI 0.42-0.50]), history of type 2 diabetes (OR 1.70 [95%CI: 1.19-2.43]), previous episodes of cholecystitis (OR 4.58 [95%CI: 1.57-13.38]), previous endoscopic retrograde cholangiopancreatography (OR 2.29 [95%CI: 2.00-2.65]), diagnosis of cholecystitis (OR 4.24 [95%CI: 3.84-4.68]), and duration of symptoms for more than 72 hours (OR 2.48 [95%CI: 1.24-4.99]).

The identification of the aforementioned preoperative risk factors are of vital importance for the general surgeon. Actively investigating these characteristics during the preoperative evaluation allows for the anticipation of potential technical difficulties, reduction of complication risks, and improvement of intraoperative decision-making. Other factors such as obesity, age, and prior abdominal surgery did not show a significant association, but the available literature presents controversial evidence regarding their association with difficult cholecystectomy