Role of Gender as a Preoperative Predictor of Difficult Laparoscopic Cholecystectomy
Submission: 25 October 2025 | Acceptance: 20 November 2025 | Publication: 20 December 2025
1Dr Javaid Iqbal, 2Waqar Manzoor, 3Dr Kaleem Akhtar, 4Khawar Qayyum, 5Sobia Wajid,
6Abbas Ali
1
Prof of Surgery, Continental Medical college Lahore.
2
Mayo Hospital Lahore
3
Karachi Institute of Medical Sciences Karachi
4
PIMS Islamabad
5
PIMS
6
RIC Rawalpindi
Abstract
Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstone
disease, though difficult LC continues to pose significant operative challenges. Several patient-related risk
factors have been described, yet the role of gender as a predictive factor remains debated. This study aimed
to evaluate the association between gender and difficult LC in a Pakistani population.
Methods: A cross-sectional analytical study was conducted in the Department of General Surgery, Federal
Government Polyclinic Hospital, Islamabad, over three months. A total of 190 patients undergoing elective
LC were enrolled through consecutive sampling. Inclusion criteria were patients of either gender aged 18–
90 years, while those with prior biliary drainage procedures, choledocholithiasis, or hepatobiliary
malignancies were excluded. Difficult LC was defined as dissection complicated by adhesions,
inflammatory changes, or anatomical distortion. Demographic data, comorbidities, preoperative
presentation, intraoperative findings, and postoperative outcomes were documented. Data were analyzed
using SPSS version 26.0, with Chi-square test applied for categorical variables and p<0.05 taken as
statistically significant.
Results: Out of 190 patients, 62 (32.6%) were males and 128 (67.4%) were females. Male patients were
significantly older than females (46.2 ± 11.7 vs. 39.5 ± 12.2 years, p=0.000). Hospitalization for acutecholecystitis was more common among males (24.1%) compared to females (12.5%, p=0.041). Difficult LC
occurred in 46.7% of males and 26.6% of females (p=0.005). Adhesions were also more frequent in males
(27.4% vs. 14.8%, p=0.038). No significant gender differences were noted in conversion to open surgery
(3.2% vs. 2.3%, p=0.722) or postoperative complications (9.6% vs. 6.2%, p=0.396).
Conclusion: Male gender is significantly associated with difficult LC, primarily due to higher rates of
adhesions and inflammatory changes. While postoperative outcomes did not differ by gender, awareness of
this association may enhance surgical preparedness and improve perioperative management strategies.
Keywords: Laparoscopic cholecystectomy; gender; adhesions; gallstones; difficult surgery