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Observational Study
. 2023 Apr;37(4):2611-2625.
doi: 10.1007/s00464-022-09659-z. Epub 2022 Nov 10.

Evaluation of 30-day morbidity and mortality of laparoscopic cholecystectomy: a multicenter prospective observational Indian Association of Gastrointestinal Endoscopic Surgeons (IAGES) Study

Vinaykumar B Thapar  1 , Pinky M Thapar  2 , Ramen Goel  3 , Ramesh Agarwalla  4 , Prashant H Salvi  5 , Amrit M Nasta  3 , Kamal Mahawar  6 ; IAGES Research Collaborative Group
Collaborators, Affiliations
Observational Study

Evaluation of 30-day morbidity and mortality of laparoscopic cholecystectomy: a multicenter prospective observational Indian Association of Gastrointestinal Endoscopic Surgeons (IAGES) Study

Vinaykumar B Thapar et al. Surg Endosc. 2023 Apr.

Abstract

Background: Laparoscopic cholecystectomy (LC) is the standard of care for benign gallstone disease. There are no robust Indian data on the 30-day morbidity and mortality of this procedure. A prospective multicentre observational study was conducted by the Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) to assess the 30-day morbidity and mortality of LC in India.

Materials and methods: Participating surgeons were invited to submit data on all consecutive LCs for benign diseases performed between 09/12/2020 and 08/03/2021 in adults. Primary outcome measures were 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify variables significantly associated with primary outcomes.

Results: A total of 293 surgeons from 125 centres submitted data on 6666 patients. Of these, 71.7% (n = 4780) were elective. A total LC was carried out in 95% (n = 6331). Laparoscopic subtotal cholecystectomy was performed in 1.9% (n = 126) and the procedure were converted to open in 1.4% of patients. Bile duct injury was seen in 0.3% (n = 20). Overall, 30-day morbidity and mortality were 11.1% (n = 743) and 0.2% (n = 14), respectively. Nature of practice, ischemic heart disease, emergency surgery, postoperative intensive care, and postoperative hospital stay were independently associated with 30-day mortality. Age, weight, body mass index, duration of symptoms, nature of the practice, history of Coronavirus Disease-2019, previous major abdominal surgery, acute cholecystitis, use of electrosurgical or ultrasonic or bipolar energy for cystic artery control; use of polymer clips for cystic duct control; conversion to open surgery, subtotal cholecystectomy, simultaneous common bile duct exploration, mucocele, gangrenous gall bladder, dense adhesions, intraoperative cholangiogram, and use of drain were independently associated with 30-day morbidity.

Conclusion: LC has 30-day morbidity of 11.1%, 30-day mortality of 0.2%, conversion to open rate of 1.4%, and bile duct injury rate of 0.3% in India.

Keywords: Bile duct injury; Clavien–Dindo score; Laparoscopic cholecystectomy; Morbidity; Mortality.

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Conflict of interest statement

Vinaykumar B. Thapar, Pinky M. Thapar; Ramen Goel, Ramesh Agarwalla, Prashant H. Salvi, Amrit M. Nasta, and Kamal Mahawar have no conflict of interest or financial ties to disclose.

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