Study of Complications of Laparoscopic Cholecystectomy at Teaching Institute

Laparoscopic cholecystectomy has emerged to be the gold standard management of the symptomatic gallstone disease and due to its minimally invasive nature, less postoperative pain, short hospitalization, recovery, and excellent cosmetic effects they have largely replaced open cholecystectomy [1]. With these benefits, it has become one of the most frequently done abdominal operations in the world especially in teaching schools where it is also a fundamental training process of surgical residents [2]. The disease owing to gallstones impacts on almost between 10, and 20 percent of adults and is often characterized by complications including biliary colic, acute and persistent cholecystitis, pancreatitis and obstructive jaundice, which require surgical intervention [3]. Even though laparoscopic cholecystectomy is considered a safe and effective procedure, it does not lack risks. It involves the use of trocar and pneumoperitoneum formation and dissection of the surrounding essential organs such as common bile duct and great vessels, and hence it is susceptible to intraoperative and postoperative complications [4][5].

Complications have been reported to be minor like nausea, vomiting and surgical site infection, and severe like hemorrhage, bile leak, bile duct, bowel injury and conversion to open surgery. The most severe of them is a bile duct injury, which, in most cases, is followed by a long-term hospital stay, surgical rehospitalization, and long-lasting morbidity [6][7]. Other risks are gallbladder perforation, stone spillage, port-site hernia, ileus, and cardiopulmonary consequences of pneumoperitoneum depending on various patient and surgery factors such as old age, obesity, diabetes, acute inflammation, prior abdominal surgery, and experience of the surgeon [8][9]. The differences between the levels of skills within the trainees in teaching hospitals can also influence the results, which is why there is a need to constantly monitor and audit the performance in the area of surgery [10] [11]. Other studies have documented overall complication and conversion rates of 515% and 210% respectively, depending on institutions and the complexity of cases [12]. Although the procedure is very frequent, there is still little information of the pattern and frequency of complications on a local level [13].

Objective

To determine the frequency and pattern of complications associated with laparoscopic cholecystectomy and identify factors associated with increased morbidity.

Among 155 patients, most were aged 31–45 years (43.2%, n=67), followed by 18–30 years (24.5%, n=38) and 46–60 years (23.2%, n=36), with only 9.1% (n=14) above 60 years. Females predominated (65.2%, n=101) compared to males (34.8%, n=54). Regarding BMI, 40.6% (n=63) were overweight and 20.0% (n=31) obese. Comorbidities were present in 43.9% (n=68).

Table 1. Baseline Demographic and Anthropometric Characteristics of Patients (N = 155)

Chronic cholecystitis was the leading indication for surgery (52.9%), followed by acute cholecystitis (28.4%), while smaller proportions had biliary colic or polyps. Hypertension (27.1%) and diabetes (23.9%) were the most common comorbidities, and 18.1% had previous abdominal surgery. Nearly half of the patients (47.1%) demonstrated gallbladder wall thickening, suggesting increased operative difficulty in a substantial number of cases.

Table 2. Preoperative Clinical Profile and Risk Stratification

Most procedures were completed within 90 minutes (80.6%), with only 19.4% requiring prolonged operative time. Minor intraoperative events such as gallbladder perforation (18.7%), bile spillage (15.5%), and bleeding (11.6%) were relatively common, whereas major injuries including bowel (1.9%) and bile duct injury (1.3%) were rare. Conversion to open surgery was required in 8.4%, while the vast majority (91.6%) were successfully managed laparoscopically.

Postoperative complications were generally infrequent and mild. Fever (13.5%) and surgical site infection (11.0%) were most common, whereas bile leak (3.9%) and hemorrhage (3.2%) occurred less often. Most patients (59.4%) were discharged within two days, re-intervention was needed in only 4.5%, and mortality was minimal at 0.6%, reflecting an overall favorable recovery profile.

Overall complications occurred in 38.7% of patients and were more frequent among high-risk groups. Diabetics (56.8%), obese patients (61.3%), those with acute cholecystitis (59.1%), and individuals with prior surgery (53.6%) showed higher complication rates. The strongest association was prolonged operative time exceeding 90 minutes (73.3%).

Table 3. Intraoperative Findings and Operative Events

Table 4. Postoperative Complications and Hospital Recovery

Table 5. Association of Risk Factors with Overall Surgical Complications

This paper assessed 155 patients that had Laparoscopic cholecystectomy and proved that it is generally a safe procedure with low major morbidity and low mortality rate, but still minor complications are relatively prevalent. The cohort consisted mainly of women (65.2%), middle-aged people (60.6), with an overwhelming prevalence of overweight or obesity (60.6%), and comorbidities (43.9%), which is characteristic of the gallstone disease. There were more than 80 percent indications of chronic and acute cholecystitis, and almost fifty percent of the cases exhibited thickening of the gallbladder wall, indicating that the operation would be harder [14]. These demographic and clinical trends have been reported in the prior studies [15][16]. Most of the surgeries were also performed intraoperatively, taking less than 90 minutes (80.6%), and with high laparoscopic success rate (91.6%) and low conversion rate (8.4%). Less severe cases like gallbladder perforation (18.7%), bile spill-over (15.5%), and bleeding (11.6) were common and the major injury such as bile duct (1.3) and bowel injury (1.9) were infrequent. Other studies have shown similar frequencies and the safety of the laparoscopic method is in general [17] [18].

Complications during the postoperative care were predominantly not serious (fever 13.5%, surgical site infection 11.0%, ileus 7.1%), but not a few serious complications like bile leak (3.9%) or hemorrhage (3.2%). The majority of patients (59.4) were discharged within a period of 2 days, re-intervention was not frequent (4.5) and the mortality was minimal (0.6). Past literature has reported similar trends in recovery, which indicated brief hospitalizations and positive results [19][20]. Notably, diabetics (56.8%), obese patients (61.3%), patients with acute cholecystitis (59.1%), patients with previous surgery (53.6%), and prolonged operating time (over 90 minutes) (73.3%), had the highest comorbidity rates, which is also evident in past studies. On the whole, a close selection of patients, preoperative optimization, and veteran surgical oversight can help to reduce complications and increase the outcomes.

It is concluded that Laparoscopic cholecystectomy is a safe and effective procedure with a high success rate and low mortality; however, minor complications remain relatively common, particularly in patients with identifiable risk factors. These findings indicate that while laparoscopic cholecystectomy generally offers favorable recovery and short hospital stay, outcomes are strongly influenced by patient comorbidities and operative difficulty. Careful preoperative optimization, risk stratification, and experienced surgical supervision are essential to minimize complications and further improve surgical safety and patient outcomes.

1.     Li ZZ, Guan LJ, Ouyang R, Chen ZX, Ouyang GQ, Jiang HX. Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019. World J Gastrointestinal Surg. 2023;15(11):2564–2578. doi:10.4240/wjgs.v15.i11.2564

2.     Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7(2):132–140. doi:10.1007/s11894-005-0051-8

3.     Eurostat surgical operations and procedures performed in hospitals by ICD-9-CM. Available from: https://ec.europa.eu/eurostat/databrowser/view/HLTH_CO_PROC2__custom_3199068/default/table?lang=en(open in a new window).

4.     Nawacki Ł, Kozłowska-Geller M, Wawszczak-Kasza M, Klusek J, Znamirowski P, Głuszek S. Iatrogenic injury of biliary tree-single-centre experience. Int J Environ Res Public Health. 2022;20(1):781. doi:10.3390/ijerph20010781

5.     Fletcher R, Cortina CS, Kornfield H, et al. Bile duct injuries: a contemporary survey of surgeon attitudes and experiences. Surg Endosc. 2020;34(7):3079–3084. doi:10.1007/s00464-019-07056-7

6.     Nair A, Al-Aamri HHM, Borkar N, Rangaiah M, Haque PW. Application of enhanced recovery after surgery pathways in patients undergoing laparoscopic cholecystectomy with and without common bile duct exploration: a systematic review and meta-analysis. Sultan Qaboos Univers Med J. 2023;23(2):148–157. doi:10.18295/squmj.1.2023.005

7.     Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc. 2019;33(4):996–1019. doi:10.1007/s00464-019-06693-2

8.     Society of American Gastrointestinal and Endoscopic Surgeons. Gallbladder removal surgery (Cholecystectomy) patient information from SAGES. Available from: https://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-gallbladder-removal-cholecystectomy-from-sages/(open in a new window).

9.     Maheta B, Shehabat M, Khalil R, et al. The effectiveness of patient education on laparoscopic surgery postoperative outcomes to determine whether direct coaching is the best approach: systematic review of randomized controlled trials. JMIR Perioper Med. 2024;7:e51573. doi:10.2196/51573

10.   Tian YQ, Lv XF, Zhang M, Gao M, Zhao L. Implementation of pathway-based care for patients undergoing daytime cholecystectomy. Patient Prefer Adherence. 2025;19:383–392. doi:10.2147/ppa.S492763

11.   Bollschweiler E, Apitzsch J, Obliers R, et al. Improving informed consent of surgical patients using a multimedia-based program? Results of a prospective randomized multicenter study of patients before cholecystectomy. Ann Surg. 2008;248(2):205–211. doi:10.1097/SLA.0b013e318180a3a7

12.   Da Silva Schulz R, Santana RF, Dos Santos CTB, et al. Telephonic nursing intervention for laparoscopic cholecystectomy and hernia repair: a randomized controlled study. BMC Nurs. 2020;19(1):38. doi:10.1186/s12912-020-00432-y

13.   Sadeghi N, Salari N, Jalali R. Effect of multimedia education on anxiety and pain in patients undergoing laparoscopic cholecystectomy: a Solomon four-group randomized controlled trial. Sci Rep. 2025;15(1):9357. doi:10.1038/s41598-024-77207-x

14.   De Rouck R, Wille E, Gilbert A, Vermeersch N. Assessing artificial intelligence-generated patient discharge information for the emergency department: a pilot study. Int J Emerg Med. 2025;18(1):85. doi:10.1186/s12245-025-00885-5

15.   Parente DJ. Generative artificial intelligence and large language models in primary care medical education. Fam Med. 2024;56(9):534–540. doi:10.22454/FamMed.2024.775525

16.   Bui D, Nakamura C, Bray BE, Zeng-Treitler Q. Automated illustration of patients instructions. AMIA Annu Symp Proc. 2012;2012:1158–1167.

17.   Choi JY, Yoo TK. Evaluating ChatGPT-4o for ophthalmic image interpretation: from in-context learning to code-free clinical tool generation. Informatics Health. 2025;2(2):158–169. doi:10.1016/j.infoh.2025.07.002

18.   Halaseh FF, Yang JS, Danza CN, Halaseh R, Spiegelman L. ChatGPT’s role in improving education among patients seeking emergency medical treatment. West J Emerg Med. 2024;25(5):845–855. doi:10.5811/westjem.18650

19.   Ye C, Malin BA, Fabbri D. Leveraging medical context to recommend semantically similar terms for chart reviews. BMC Med Inform Decis Mak. 2021;21(1):353. doi:10.1186/s12911-021-01724-2

20.   Zaretsky J, Kim JM, Baskharoun S, et al. Generative artificial intelligence to transform inpatient discharge summaries to patient-friendly language and format. JAMA Network Open. 2024;7(3):e240357. doi:10.1001/jamanetworkopen.2024.0357