Introduction : Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedure. However, preoperative predictors of difficult LC are not clear.

Methods : A retrospective study of patients undergoing LC from April 2017 to December 2017 was conducted. Operative time was used as a surrogate marker of surgical difficulty. Operative time ≥ 90 minutes was considered difficult operation.

Results : Out of 76 patients included, 47 were females and 29 were males. The mean operative time and blood loss was 117.1±32.6 minutes and 54±29 ml respectively. One patient required conversion to open surgery due to difficult Calot’s anatomy. Thirty-nine patients had operative time ≥ 90 minutes. On univariate analysis, presence of acute cholecystitis (AC) (p=0.001) and history of pancreatitis (p=0.047) significantly affected the operative time. On multivariate analysis, presence of AC was the only independent predictor of operative time ≥ 90 minutes (p=0.005). Patients with longer operative time had significantly higher blood loss (p=0.000), postoperative complications (p=0.004) and hospital stay (p=0.016). Among patients with AC, nine underwent LC within 4 days, seven patients between 5-14 days and three patients after two weeks of onset of symptoms. On subgroup analysis of patients with acute cholecystitis (n = 19), duration of symptoms had no impact on the operative time (p=0.574) or blood loss (p=0.835).

Conclusions : Acute cholecystitis is associated with difficult LC with increased operative time, blood loss and complications. However, the timing of surgery in acute cholecystitis has no impact on the outcomes of LC.