Gender-Based Differences in the Risk of Difficult Laparoscopic Cholecystectomy: A Preoperative Assessment
Submission: 25 October 2025 | Acceptance: 20 November 2025 | Publication: 20 December 2025
1Dr Javaid Iqbal, 2Talha Niaz, 3Dr Kaleem Akhtar, 4Khawar Qayyum, 5Sobia Wajid, 6Abbas Ali
1Prof of Surgery, Continental Medical college Lahore.
2 Bangrilla Community hospital Jatti Dehri Bangrilla Mirpur Azad Kashmir
3Karachi Institute of Medical Sciences Karachi
4PIMS Islamabad
5PIMS
6RIC 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 acute cholecystitis 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