{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:08:18Z","timestamp":1753870098976,"version":"3.41.2"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T00:00:00Z","timestamp":1694908800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prediction of difficult laparoscopic cholecystectomy may help in making necessary arrangements for optimal intraoperative requirements and postoperative care. This study was conducted to examine the factors associated with and outcomes of difficult laparoscopic cholecystectomy performed at the Bhutan's largest hospital in 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a cross\u2010sectional study with a convenience sampling method. Data on clinical features, ultrasonography and intraoperative factors of patients who underwent laparoscopic cholecystectomy were extracted from their medical records, investigation reports and intraoperative surgery note. Difficult laparoscopic cholecystectomy was defined on the basis of the duration of the surgery, injury to bile duct or artery, or conversion to open cholecystectomy. Data were double entered and validated in EpiData 3.1 and analysed in STATA 13.0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 134 patients were extracted. The mean age of the sample was 43 (\u00b1SD 13) years. \u201cDifficult laparoscopic cholecystectomy\u201d was reported in 83 patients (62%) and easy laparoscopic cholecystectomy in 51 patients (38%). Those patients having simple adhesions up to the body of the gall bladder were 1.6 times more likely to encounter difficult laparoscopic cholecystectomy (adjusted PR\u00a0=\u00a01.60, 95% CI 1.04\u20132.48, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.034). The majority did not have any post\u2010operative complications (130 cases, 97%). The indications of laparoscopic cholecystectomy were symptomatic gall stone disease (129, 96%), acalculous cholecystitis (2, 1%) and gall bladder polyp (3, 2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The proportion of difficult laparoscopic cholecystectomy is high, but the rates of post\u2010operative complications were minimal with no mortality or injury to bile duct or arteries.<\/jats:p><\/jats:sec>","DOI":"10.1002\/puh2.122","type":"journal-article","created":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T16:03:01Z","timestamp":1694966581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic cholecystectomy in a resource limited setting: Factors associated with difficult surgeries at the National Referral Hospital, Bhutan"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-7217","authenticated-orcid":false,"given":"Sangay","family":"Wangmo","sequence":"first","affiliation":[{"name":"Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan  Thimphu Bhutan"},{"name":"Department of Surgery Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4411-9471","authenticated-orcid":false,"given":"Sonam","family":"Dargay","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan  Thimphu Bhutan"},{"name":"Department of Surgery Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonam","family":"ChhodenR","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan  Thimphu Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2018.03.004"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-6281-2"},{"key":"e_1_2_11_4_1","article-title":"Laparoscopic cholecystectomy performed by residents: a retrospective study on 569 patients","volume":"2014","author":"Pariani D","year":"2014","journal-title":"Surg Res 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