Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: a single surgeon experience

Which Is More Effective: Laparoscopic or Open Partial Cholecystectomy?

Objective: In laparoscopic cholecystectomy, partial cholecystectomy is usually preferred when the anatomic exploration is not enough to prevent bile duct injury and other complications. Some surgeons choose laparoscopically to perform partial cholecystectomy, whereas others convert to open surgery. In this study, we aim to discuss and compare the effectiveness of laparoscopic partial cholecystectomy (LPC) and open partial cholecystectomy (OPC). Materials and Methods: The data of 4712 patients who underwent laparoscopic cholecystectomy between 2012 and 2020 were reviewed. A total of 98 patients who had partial cholecystectomy were included in the study. Patients were examined in two groups according to whether the procedure was open or laparoscopic. The first group of patients was named the OPC group (n = 52), and the second group of patients was the LPC group (n = 46). The data of the two groups were comparatively analyzed. Results: The mean operative time and the postoperative hospital stay, respectively, were 118.2 minutes and 4.8 days in the OPC group, and 87.3 minutes and 2.55 days in the LPC group (P < .005 and P = .005). It was found that wound infection decreased by 83.1% (P = .026; odds ratio [OR] = 0.169) in the LPC group compared with the OPC group, and the probability of developing incisional hernia decreased by 81.1% (P = .014; OR = 0.189). At least one complication was observed in 17 patients in the OPC group and in 7 patients in the LPC group (P = .045). The probability of developing complications in any patient was 63% lower in the LPC group (P = .049; OR = 0.370). Conclusions: The indications that cause the surgeon to perform partial cholecystectomy are inherently open to complications, regardless of the surgical technique used. However, the laparoscopic operation has advantages such as shorter operation time, shorter postoperative hospital stay, lower risk of wound infection and incisional hernia rate, and lower complication rate than the open procedure. However, if the team performing the surgery does not have enough experience, they should never hesitate to switch to open cholecystectomy.

Gender Disparities in the Presentation of Gallbladder Disease

Although gallbladder disease (GBD) is more common in females, we have noticed a trend toward more complicated cases in male patients. We reviewed all cholecystectomies performed at our institution over the last five years. After eliminating cases with confounding variables, we identified 1529 records. Charts were reviewed for age, gender, BMI, procedure performed, operative time, length of stay, and preoperative diagnosis. Descriptive and inferential statistical analyses were conducted along with linear regression. There were 1444 laparoscopic, 64 laparoscopic converted to open, and 21 primary open cases. Patients were 1008 (66%) females and 521 (34%) males. Average operative time was 89.8 minutes. Cholecystectomy averaged 17.7 minutes longer in males ( P = 0.0046). Two per cent of female patients and 7.9 per cent male patient converted to open. Males were more likely to have complicated GBD, whereas women had uncomplicated disease. Average age was 51.9 years for males versus 42.7 years for females. Age, gender, BMI, length of stay, and preoperative diagnosis were all independently significant in predicting operative time. In our study, women presented with uncomplicated GBD, whereas men presented with complicated GBD. This suggests that male patients present at a later stage of disease.

Epidemiological and clinical assessment of patients undergoing Videolaparoscopic Cholecystectomy at a Curitiba teaching hospital

OBJECTIVE

to assess clinical and epidemiological factors of patients undergoing video cholecystectomy at the Hospital da Cruz Vermelha do Paraná, Curitiba unit, operated from September 2016 to September 2018, as well as the influence of comorbidities, sex and advanced age on the postoperative prognosis, while in the hospital.

METHODS

Analytic retrospective study. The analyzed variables were obtained by the review of medical records. Statistical analyses were performed considering the significance level p < 0.05.

RESULTS

389 patients, of whom 265 were women and 124 men, were included. The mean age was 51.5 years, 58.8% of the patients were diagnosed with at least one comorbidity, and 74.6% were overweight or obese. The incidence of intraoperative complications was 1.3%, postoperative 3.8% and, mortality, 0.3%. Some risk factors were identified as worse postoperative prognosis, such as Diabetes Mellitus, hypertension, presence of one or more comorbidities and mainly, advanced age, which was related to longer hospitalization times (p < 0,001), need of intensive therapy (p < 0,001), conversion to open surgery (p = 0,003) and postoperative complications (p < 0,001). Furthermore, the male sex was predictive of longer hospitalization times (p = 0,003) and need of intensive therapy (p = 0,01).

CONCLUSION

the presence of comorbidities, male sex, and advanced age are predictive factors of bad prognosis for patients undergoing video laparoscopic cholecystectomy.

DOES MALE GENDER INCREASE THE RISK OF LAPAROSCOPIC CHOLECYSTECTOMY?

Background:

Laparoscopic cholecystectomy is the preferable treatment for chronic or acute cholecystitis. Some factors may increase the rate of laparoscopic conversion to open cholecystectomy and perioperative complications. The role of gender as a risk factor for laparoscopic cholecystectomy is controversial.

Aim:

To evaluate the role of the gender on the operative findings and outcome of laparoscopic cholecystectomy.

Method:

All patients who underwent laparoscopic cholecystectomy for chronic or acute cholecystitis were included. Demographic, clinical, laboratory, imaging exams, intraoperative and postoperative data were obtained and analyzed. The data was obtained retrospectively from electronic medical records and study protocols.

Results:

Of a total 1,645 patients who were subjected to laparoscopic cholecystectomy, 540 (32.8%) were men and 1,105 (67.2%) were women. Mean age was similar in both genders (p=0.817). Operative time has longer in the male (72.48±28.50) than in the female group (65.46±24.83, p<0.001). The rate of acute cholecystitis was higher in the male (14.3%) than in the female group (5.1%, p<0.001). There was no difference between the genders in regard to the rate of conversion (p=1.0), intraoperative complication (p=1.0), postoperative complication (p=0.571), and operative mortality (p=1.0).

Conclusion:

Male gender is not an independent risk factor for laparoscopic conversion and perioperative complications.

Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?

This paper was designed to investigate the gender dependent risk of complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Laparoscopic cholecystectomy is the standard procedure for benign gallbladder disorders. The role of gender as an independent risk factor for complicated laparoscopic cholecystectomy remains unclear. A retrospective single-center analysis of laparoscopic cholecystectomies performed for acute cholecystitis over a 5-year period in a community hospital was performed. Within the period of examination, 1884 laparoscopic cholecystectomies were performed. The diagnosis was acute cholecystitis in 779 cases (462 female, 317 male). The male group was significantly older (P = 0.001). Surgery lasted significantly longer in the male group (P = 0.008). Conversion was done in 35 cases (4.5%). There was no significant difference in the rate of conversion between both groups. However the rate of conversion was significantly higher in male patients > 65 years (P = 0.006). The length of postoperative hospital stay was significantly longer in the male group (P = 0.007), in the group > 65 years (P = 0.001) and following conversion to open surgery (P = 0.001). The male gender was identified as an independent risk factor for prolonged laparoscopic cholecystectomy on multivariate analysis. The male gender could be an independent risk factor for complicated or challenging surgery in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

[Not Available]

OBJECTIVES

Database review to analyse age and sex differences in complication and conversion rates and influence on return to normal daily activities and work after laparoscopic cholecystectomy (LC).

METHODS

658 patients had a laparoscopic cholecystectomy for proven gallstones between 9/4/2001 and 15/2/2006 under the care of one surgeon (F. H.) at Benenden hospital, Kent, UK.

RESULTS

We had a 65.5% response rate with 431 replies at a mean follow up of 22.4 months (2.3-52.8). There was a male to female ratio of 5:23 with a mean age of 54.2 years (22-83). Using linear regression we found no significant correlation with operative time and variables of age and sex (df = 2, 251, R (2) = 0.03, F = 0.574, p < 0.564). No significant correlation with number of complications and age or sex (df = 2, 334, R (2) = 0.004, F = 1.615, p < 0.200). Age (Exp(B) = 1.040, p < 0.51) and sex (Exp(B) = 0.863, p < 0.855) had no effect on conversion. No difference was found in relation to age and sex with return to normal daily activities (df = 2, 307, F = 0.904, p < 0.406). Age was a non-significant predictor of return to work (Beta = 0.040, p < 0.572) however men return to work significantly sooner (Beta = 0.191, p < 0.007).

CONCLUSIONS

Operative time, number of complications, conversion to open and return to normal daily activities may not be affected by age or sex of patients. Hospital stay may be longer in older patients. Men appear to return to work sooner. Further analysis with validated questionnaires are required.

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

OBJECTIVE

Laparoscopic cholecystectomy has become the "gold standard" for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly.

MATERIAL AND METHODS

The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared.

RESULTS

The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications.

CONCLUSION

LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.

Male gender impact on the outcome of laparoscopic cholecystectomy

BACKGROUND AND OBJECTIVES

Our aim was to assess the impact of male gender on the outcomes of laparoscopic cholecystectomy by eliminating associated risk factors for conversion.

METHODS

A quantitative comparative study was set up on the background of our null hypothesis that male gender has no impact on the outcomes of laparoscopic cholecystectomy. We performed a retrospective study of 241 patients and recorded the duration of surgery, length of postoperative hospital stay, conversion rate, and procedure-specific complications. Risk factors for conversion were excluded. Inferential statistics were applied, and a 2-sided P value of < .05 was considered the cutoff point to indicate the amount of evidence against the null hypothesis. We used SPSS for Windows, version 12 (IBM, Armonk, New York). Parametric data were analyzed with the independent-samples t test, and nonparametric data were analyzed with the χ(2) test.

RESULTS

A total of 175 women (72.6%) and 66 men (27.4%) underwent laparoscopic cholecystectomy. The mean age was 51.4 ± 14.8 years for women and 55 ± 12.7 years for men (P = .08). Women had a higher body mass index (28.4 ± 4.5) than men (26.8 ± 3.5) (P < .005). There were no statistically significant differences in the conversion rate and perioperative morbidity rate. The conversion rate was 2.9% for women and 7.5% for men (P = .142); the morbidity rate was 10.2% and 12.1%, respectively (P = .66). The mean duration of surgery was longer in men, at 67.9 ± 27.8 minutes, than in women, at 56.5 ± 23.98 minutes (P < .002). Both genders had an equal length of postoperative hospital stay, with 1.9 ± 1.8 days for men and 1.9 ± 2.1 days for women (P = .8).

CONCLUSIONS

Male gender has no impact on the outcomes of laparoscopic cholecystectomy. Gender affects the duration of surgery. Larger-scale studies may disclose the factors responsible for variations in the operative time.

Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience

INTRODUCTION

The aim of our study was to determine the effect of sex on the outcome of laparoscopic cholecystectomy in terms of operative time, conversion to open cholecystectomy, postoperative complications and mean hospital stay.

METHODS

In this retrospective observational study, we analyzed the medical records of 2061 patients who underwent laparoscopic cholecystectomy in the surgical department of Khyber Teaching Hospital (Peshawar, Pakistan) between March 2008 and January 2010. χ(2) test and t-test were respectively used to analyze categorical and numerical variables. P ≤ 0.05 was considered significant.

RESULTS

The study included 1772 female and 289 male patients. The mean age for male patients was 44.07 ± 11.91 years compared to 41.29 ± 12.18 years for female patients (P = 0.706). Laparoscopic cholecystectomy was successfully completed in 1996 patients. The conversion rate was higher in men (P < 0.001), and the mean operating time was longer in men (P < 0.001). Bile duct injuries occurred more frequently in men (P < 0.001). Gallbladder perforation and gallstone spillage also occurred more commonly in men (P = 0.001); similarly severe inflammation was reported more in male patients (P = 0001). There were no statistically significant differences in mean hospital stay, wound infection and port-site herniation between men and women. Multivariate regression analysis showed that the male sex is an independent risk factor for conversion to open cholecystectomy (odds ratio = 2.65, 95% confidence interval: 1.03-6.94, P = 0.041) and biliary injuries (odds ratio = 0.95, 95% confidence interval: 0.91-0.99, P-value = 0.036).

CONCLUSIONS

Laparoscopic cholecystectomy is often challenging in men on account of more adhesions and inflammation. This leads to higher conversion rates and more postoperative complications. Optimized planning and a more experienced operating surgeon may help overcome these problems.

Laparoscopic cholecystectomy in a single, non-teaching hospital: an analysis of 1557 patients

BACKGROUND

Laparoscopic cholecystectomy may lead to serious complications, although it is the gold standard treatment for gallstones. In this article, the aim was to review our experience with laparoscopic cholecystectomies.

SUBJECTS AND METHODS

All laparoscopic cholecystectomies were performed in a single, non-teaching hospital between January 2000 and October 2010 and were reviewed retrospectively to analyze the effect of preoperative risk factors on outcome and the associated major complications.

RESULTS

This study included 1557 laparoscopic cholecystectomies, and the mean age of the patients was 54.1±12.3 years. The mean duration of the operation and the mean length of stay were 43.4 minutes and 1.2 days, respectively. Conversion to an open cholecystectomy was necessary in 39 patients, and thus the conversion rate was 2.5%. In total, 57 (3.7%) complications occurred in 51 patients. Serious common bile duct injury was seen in 4 (0.27%) cases. The other common complications included bile leakage in 10 (0.64%) and postoperative bleeding in 7 (0.45%) patients. The mortality rate was 0.13%. Risk factors for conversion to open surgery were male gender, age >55 years, emergency admission due to acute cholecystitis, and a history of previous acute cholecystitis attacks. Factors that increased the morbidity rate were male gender, an American Society of Anesthesiologists score of III, emergency admission due to acute cholecystitis, and a history of previous acute cholecystitis attacks.

CONCLUSIONS

Our results may serve as a baseline for comparison with future studies done at single, non-teaching hospitals where surgical teams perform laparoscopic cholecystectomies over a long period of time.

Is laparoscopic cholecystectomy more challenging in male patients?

BACKGROUND

Laparoscopic cholecystectomy (LC) seems to be more challenging in males than in females. The surgery seems to be longer in male patients. There also seems to be an increased rate of conversion to open surgery in male patients. We sought to objectively verify this widespread belief.

METHODS

We performed a retrospective analysis of laparoscopic cholecystectomies performed between January 2004 and November 2009 in our hospital. Within this period 1844 cholecystectomies were performed in our community-based hospital. After a strict inclusion procedure, 1571 cases of LC for symptomatic gallbladder disease were analyzed (501 males, 1071 females). The time for surgery, defined as the interval from placement of the Veress needle to wound closure in minutes, and the rate of conversion to open surgery were the main parameters considered.

RESULTS

The time for surgery in male patients was significantly longer compared to that for females (p<0.0001). The male cohort was significantly older than the female cohort at the time of surgery (p<0.001). The rate of conversion to open surgery was significantly higher in male patients (5.6%) compared to 2.9% for females (p<0.0001).

CONCLUSION

Based on our analysis, LC had a significantly longer duration of surgery in the male cohort. The rate of conversion to open surgery was also significantly higher in male cohort. Thus, LC could be more challenging in male patients.

Outcome of laparoscopic cholecystectomy at a secondary level of care in Saudi Arabia

BACKGROUND/AIM

The first option for gallbladder surgery is laparoscopic cholecystectomy. The aim of this study is to analyze the outcomes for all patients who underwent laparoscopic cholecystectomy at a secondary level of care.

PATIENTS AND METHODS

Between 2005 and 2008, 968 consecutive laparoscopic cholecystectomies were performed at King Fahad Hospital. We collected and analyzed data including age, gender, body mass index (kg/m2), the American Society of Anesthesiologists (ASA) class, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis [AC]), co-morbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay.

RESULTS

Nine hundred and sixty-eight patients had laparoscopic cholecystectomy at the center. There were 824 females and 144 males; the age range was 15-64 (mean 32.9 ± 12.7 years). The operating time was 45 to 180 min (median 85 min); the complication rate was 4.03% (39 patients).

CONCLUSION

Laparoscopic cholecystectomy could be performed safely in the majority of patients with cholelithiasis, by an experienced surgical team at a secondary level of care.

The outcome of laparoscopic cholecystectomy in diabetic patients: a prospective study

BACKGROUND

Diabetes mellitus is considered a risk factor associated with morbidity in patients who undergo laparoscopic cholecystectomy (LC), in comparison with nondiabetics. The aim of this study was to evaluate this risk factor in Saudi patients and evaluate the outcome LC in diabetic patients with nondiabetics.

PATIENTS AND METHODS

We analyzed data from 968 patients with symptomatic gallbladder stones who underwent an LC between January 2005 and June 2008. Age, sex, operative records, morbidity, and length of hospital stay for each patient were analyzed.

RESULTS

There were 175 (18%) diabetic and 793 nondiabetic patients. There was no significant difference between the two groups regarding complication, conversion to open, or operative time. Length of hospital stay was significantly different in the two groups.

CONCLUSIONS

LC in diabetic patients had the same outcome in nondiabetic patients. Careful preoperative preparations, meticulous intraoperative surgical technique, and cautious postoperative care are mandatory to achieve this outcome.