Intraoperative Findings and Difficulties Encountered During Laparoscopic Cholecystectomy: An Observational Study

Abstract

Background: Laparoscopic cholecystectomy is the standard intervention for symptomatic gallstone disease; however, intraoperative challenges can prolong surgery or increase complications. Objective: This study evaluated the frequency and determinants of operative difficulties. Methods: A prospective observational study was conducted among 67 patients undergoing laparoscopic cholecystectomy at Green Life Medical College Hospital between January 2022 and December 2023. Patients with cirrhosis, malignancy, prior upper abdominal surgery, or coagulation disorders were excluded. Intraoperative variables, including gallbladder wall thickness, adhesions, anatomical variations, and dissection complexity, were documented. Results: Standard procedures were completed in 76.1% of cases, whereas 14.9% were classified as difficult. Distended or congested gallbladder (32.8%) and omental wrapping (20.9%) were common findings. Thick gallbladder wall _3 mm, dense adhesions, and difficult Calot’s triangle dissection independently predicted operative difficulty. Conclusion: Preoperative identification of gallbladder wall thickening, adhesions, and complex Calot’s triangle anatomy may help anticipate a challenging laparoscopic cholecystectomy.

J Rang Med Col.2026 Mar;11(1): 196-201