Incidence and Risk Factors of Intraoperative Complications duringLaparoscopic Cholecystectomy in a Tertiary Care Hospital

Abstract

 Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease, yet
intraoperative complications (IOCs) remain a persistent concern, with reported incidences varying widely.
Objective: To determine the incidence and identify risk factors of IOCs during LC in a Portuguese tertiary care setting.
Methods: A retrospective observational study was conducted at the Department of General Surgery, Unidade Local de Saúde
Alentejo Central, Évora, Portugal, between February 2021 and November 2021. A total of 48 consecutive patients undergoing LC
were included. Demographic, clinical, and operative data were collected, and univariate analyses were performed to identify factors
associated with IOCs.
Results: The overall incidence of IOCs was 18.8% (9/48). Gallbladder perforation with bile spillage (10.4%) and intraoperative
bleeding (6.3%) were the most frequent events. A single major bile duct injury (2.1%) occurred. Univariate analysis identified acute
cholecystitis (p = 0.012), a thickened gallbladder wall on ultrasound (p = 0.008), and an operating surgeon with fewer than 50 prior
LC procedures (p = 0.021) as significant risk factors for IOCs. The conversion rate to open surgery was 6.3%.
Conclusion: IOCs during LC remain a clinically relevant entity in a low-volume, real-world setting. Surgeon experience and
markers of operative difficulty are key modifiable risk factors, underscoring the need for structured training and careful preoperative
risk stratification.