{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:37:24Z","timestamp":1787319444516,"version":"build-2736575974"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Difficult intra\u2010operative findings during laparoscopic cholecystectomy (LC) may lead to poor clinical outcomes. This study aimed to compare pre\u2010operative, intra\u2010operative, and post\u2010operative variables of patients with \u2018straightforward\u2019 versus \u2018difficult\u2019 intra\u2010operative findings and to assess the relationship between intra\u2010operative findings and post\u2010operative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of prospectively collected data from patients undergoing LC from August 1998 to December 2020 was conducted. Intra\u2010operative findings were graded using the North Shore system, with Grade 1 or 2 classified as \u2018straightforward\u2019 LC and Grade 3 or 4 as \u2018difficult\u2019 LC. Logistic regression analyzed the relationship between poor post\u2010operative outcomes and intra\u2010operative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2633 patients, 2050 (78%) had \u2018straightforward\u2019 and 583 (22%) had \u2018difficult\u2019 intra\u2010operative findings. Patients with \u2018difficult\u2019 findings were often younger, male, jaundiced, had higher Charlson Comorbidity Indexes (CCI), and were more likely to undergo urgent or semi\u2010urgent operations in the public hospital. They experienced longer operation times, higher cholangiogram failure rates, more common bile duct explorations, longer hospital stays, higher conversion rates to open procedures, a greater risk of post\u2010operative bile leaks, and higher rates of hospital readmission post\u2010discharge. Higher CCI, pancreatitis, and intra\u2010operative challenges such as CBD exploration and \u2018difficult\u2019 intra\u2010operative findings were predictive of poor post\u2010operative outcomes. The financial impact of \u2018difficult\u2019 intra\u2010operative findings is significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is an association between \u2018difficult\u2019 intra\u2010operative findings and adverse clinical outcomes, confirming the negative financial impact of a less\u2010than Textbook Outcome. This highlights the need to anticipate and make appropriate resources available for potentially challenging LCs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70113","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T07:59:33Z","timestamp":1745481573000},"page":"926-933","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical and financial impact of a \u2018difficult\u2019 laparoscopic cholecystectomy"],"prefix":"10.1111","volume":"95","author":[{"given":"Yue","family":"Yu","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit Royal North Shore Hospital and North Shore Private Hospital  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0590-2153","authenticated-orcid":false,"given":"Siobhan C","family":"McKay","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit Royal North Shore Hospital and North Shore Private Hospital  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3995-4285","authenticated-orcid":false,"given":"Nazim","family":"Bhimani","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit Royal North Shore Hospital and North Shore Private Hospital  St Leonards New South Wales Australia"},{"name":"Faculty of Medicine and Health University of Sydney  New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-0832","authenticated-orcid":false,"given":"Isaac","family":"Tranter\u2010Entwistle","sequence":"additional","affiliation":[{"name":"Department of General Surgery Christchurch Hospital  Christchurch New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6690-342X","authenticated-orcid":false,"given":"Thomas J.","family":"Hugh","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit Royal North Shore Hospital and North Shore Private Hospital  St Leonards New South Wales Australia"},{"name":"Northern Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1615\/JLongTermEffMedImplants.v15.i3.90"},{"key":"e_1_2_7_3_1","unstructured":"Welfare AIoHa.Australian Burden of Disease Study 2022.2022."},{"key":"e_1_2_7_4_1","article-title":"Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis","author":"Keus F","year":"2006","journal-title":"Cochrane Database Syst. 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