VARIOUS SURGICAL MODIFICATIONS VERSUS TRADITIONAL TECHNIQUE OF LAPROSCOPIC CHOLECYSTECTOMY IN MANAGEMENT OF DIFFICULT GALLBLADDER AND THEIR SURGICAL OUTCOME: A PROSPECTIVE INTERVENTIONAL COMPARATIVE STUDY

Abstract

Background: Difficult gallbladder cases remain technically demanding due to inflammation, adhesions, and distorted anatomy, often requiring deviation from the standard laparoscopic approach. We conducted this study, to compare surgical outcomes between traditional and modified laparoscopic cholecystectomy techniques in difficult gallbladder cases. Methods:This prospective interventional comparative study was conducted on 40 patients, randomly aaaigned to traditional (n=8) and modified technique groups (n=32). Modified techniques included fundus-first, intraluminal, combined antegrade–retrograde dissection, and stump stenting. We followed patients for intraoperative and postoperative outcomes. Results: In the present study, we found that patients who had modified laparoscopic cholecystectomy were much older (50.69 ± 12.84 years) than traditional group (38.25 ± 12.43 years); p=0.018, with a relatively higher number of males. In modified group, the incidence of acute cholecystitis (71.88 vs. 50.00), frozen anatomy (62.50 vs. 50.00) and complex conditions were significantly higher but the operative times was comparable (63.31 vs 66.88 min; p=0.265).  We found that drain utilization and stone spillage were significantly higher in modified cases (100% vs. 87.50%; p<0.0001) and (34.38% vs. 12.50%; p<0.0001) respectively, while port-site infection was lower (9.38% vs. 25.00%; p<0.0001). Hospital stay and recovery were similar. Furthermore, predictive analysis revealed that age >50 years (RR 3.50; OR 5.44) and stone spillage (RR 2.75; OR 3.67) were moderately associated with difficult cases, while other variables showed weak or minimal associations. Conclusion: Evidently, modified laparoscopic techniques are safe and effective in difficult gallbladder cases, offering comparable operative and recovery outcomes while facilitating safer dissection in complex anatomical situations.