title: Prolonged (longer than 3 hours) laparoscopic cholecystectomy: reasons and results.
abstract: For the experienced surgeon, the average operative time for a laparoscopic cholecystectomy is less than 1 hour. There has been no study documenting the causes and results of prolonged (longer than 3 hours) surgery. A retrospective study was done of patients who underwent cholecystectomy  between January 2003 and December 2007. A total of 3126 cholecystectomies were done. After excluding patients who had a planned open cholecystectomy and patients who had additional laparoscopic surgeries, we identified 70 patients who had a planned laparoscopic cholecystectomy with operative  time exceeding 3 hours. Multivariate stepwise logistic regression was performed analyzing the various factors leading to prolonged surgery. Of the 70 patients, ranging in age from 21 to 92 years (mean, 57 years), most (n = 53) were female. Operative time ranged from 3 hours to 6 hours 40 minutes  (mean, 3 hours 37 minutes). Emergency:elective admission ratio was 9:5 and acute cholecystitis (n = 40) was the most common indication. Common characteristics were obesity (n = 44, P = 0.031), intra-abdominal adhesions (n = 43, P = 0.004), and previous abdominal surgeries (n  = 40, P = 0.002). Intraoperative complications included spillage of stones (n = 6), bile duct injury (n = 3), and bleeding (n = 3). The possibility of prolonged laparoscopic cholecystectomy should be anticipated in patients with obesity and previous abdominal operations. Prolonged surgery  increases the risk of complications (bile duct injury, bleeding) and prolongs the postoperative hospital stay.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan, USA. drsgokul@yahoo.com
authors.forename: Gokulakkrishna
authors.initials: G
authors.lastname: Subhas
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.forename: Jasneet
authors.initials: J
authors.lastname: Bhullar
authors.forename: Linda
authors.initials: L
authors.lastname: Dubay
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ferguson
authors.forename: Yousif
authors.initials: Y
authors.lastname: Goriel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: Ramachandra B
authors.initials: RB
authors.lastname: Kolachalam
authors.forename: Sumet
authors.initials: S
authors.lastname: Silapaswan
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult