{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:18:35Z","timestamp":1787023115656,"version":"build-2736575974"},"reference-count":11,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005639","name":"Universidade de S\u00e3o Paulo","doi-asserted-by":"crossref","award":["4373\/2014"],"award-info":[{"award-number":["4373\/2014"]}],"id":[{"id":"10.13039\/501100005639","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Cir. Bras."],"abstract":"<jats:p>ABSTRACT  Purpose: To identify preoperative factors predicting surgical difficulty in laparoscopic cholecystectomy at a secondary-level hospital.  Methods: A retrospective study included 697 adults undergoing laparoscopic cholecystectomy from January 2021 to June 2024. Demographic, clinical, laboratory, and ultrasound data, as well as intra- and postoperative outcomes, were collected. Operative difficulty was graded using Nassar\u2019s scale (I\u2013V). Logistic regression analyses identified predictors of difficult cholecystectomy (Nassar III\u2013V).  Results: Among the 697 patients (81.5% female; mean age 46.7 \u00b1 14.0 years old; mean body mass index 29.2 \u00b1 4.8 kg\/m2), 41.4% were classified as difficult. Conversion to open surgery occurred in 1.1%. Difficult cases showed longer operative time (79.9 \u00b1 39.3 versus 56.9 \u00b1 19.6 minutes, p 0.01), greater use of intraoperative cholangiography (12.5 versus 3.7%, p 0.01), longer postoperative stay (p 0.01), and higher incidence of nausea\/vomiting (15.2 versus 7.8%, p 0.01). Multivariate analysis identified elevated alanine transaminase (odds ratio = 2.89, 95% confidence interval 1.80\u20134.64, p 0.001) and gallbladder wall thickening 4 mm (odds ratio = 4.75, 95% confidence interval 2.85\u20137.91, p 0.001) as independent predictors.  Conclusion: Elevated alanine transaminase and gallbladder wall thickening are significant predictors of difficult laparoscopic cholecystectomy. Recognizing these factors may optimize surgical planning and enhance patient safety in non-tertiary hospitals.<\/jats:p>","DOI":"10.1590\/acb410126","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T15:04:53Z","timestamp":1768575893000},"source":"Crossref","is-referenced-by-count":1,"title":["Predictive factors of surgical difficulty in laparoscopic cholecystectomy in a secondary hospital"],"prefix":"10.1590","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7794-5934","authenticated-orcid":false,"given":"Victoria","family":"Casarim","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5279-6359","authenticated-orcid":false,"given":"Isabela Martins Soares","family":"Miranda","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4577-3975","authenticated-orcid":false,"given":"Lucas Aloisi","family":"Guedes","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4504-9067","authenticated-orcid":false,"given":"Guilherme Dourado","family":"Zambon","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9796-0339","authenticated-orcid":false,"given":"Wilson","family":"Salgado Junior","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"Suppl. 3","key":"ref1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1046\/j.0953-0673.2003.01721.x","article-title":"The burden of gallstone disease in Europe","volume":"18","author":"Aerts R","year":"2003","journal-title":"Aliment Pharmacol Ther"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/HEP.0000000000000264","article-title":"Increasing gallstone disease prevalence and associations with gallbladder and biliary tract mortality in the US","volume":"77","author":"Unalp-Arida A","year":"2023","journal-title":"Hepatology"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5005\/jp-journals-10018-1366","article-title":"The association of preoperative risk factors for laparoscopic conversion to open surgery in elective cholecystectomy","volume":"12","author":"Hanson-Viana E","year":"2022","journal-title":"Euroasian J Hepatogastroenterol"},{"issue":"1","key":"ref4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.4103\/ejs.ejs_239_23","article-title":"Preoperative predictive factors of difficult laparoscopic cholecystectomy","volume":"43","author":"Saad MR","year":"2024","journal-title":"Egypt J Surg"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s12262-009-0055-y","article-title":"Preoperative Randhawa prediction of difficult lap chole: a scoring method","volume":"71","author":"Randhawa JS","year":"2009","journal-title":"Indian J Surg"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"4549","DOI":"10.1007\/s00464-019-07244-5","article-title":"CholeS Study Group, West Midlands Research Collaborative. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system","volume":"34","author":"Nassar AHM","year":"2020","journal-title":"Surg Endosc"},{"issue":"4","key":"ref7","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.18203\/2349-2902.isj20171126","article-title":"A comprehensive review of the factors predicting technical difficulty in laparoscopic cholecystectomy","volume":"4","author":"Menon A","year":"2017","journal-title":"Int Surg J"},{"issue":"7","key":"ref8","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1177\/0003134821998664","article-title":"The role of transaminases in predicting choledocholithiasis: a novel predictive composite score development in a cohort of 1,089 patients undergoing laparoscopic cholecystectomy","volume":"88","author":"Kokoroskos N","year":"2022","journal-title":"Am Surg"},{"issue":"2","key":"ref9","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/njs.NJS_3_19","article-title":"Preoperative predictors of level of difficulty of laparoscopic cholecystectomy","volume":"25","author":"Chand P","year":"2019","journal-title":"Niger J Surg"},{"issue":"3","key":"ref10","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.18203\/2349-2902.isj20180837","article-title":"Predicting difficult laparoscopic cholecystectomy","volume":"5","author":"Gupta AK","year":"2018","journal-title":"Int Surg J"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1002\/bjs.10287","article-title":"Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases","volume":"103","year":"2016","journal-title":"Br J Surg"}],"container-title":["Acta Cir\u00fargica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-86502026000102201&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T15:04:55Z","timestamp":1768575895000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-86502026000102201&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":11,"alternative-id":["S0102-86502026000102201"],"URL":"https:\/\/doi.org\/10.1590\/acb410126","relation":{},"ISSN":["1678-2674","0102-8650"],"issn-type":[{"value":"1678-2674","type":"electronic"},{"value":"0102-8650","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e410126"}}