Outcome of Laparoscopic cholecystectomy among patients operated at a general hospital in a low-income country, Addis Ababa, Ethiopia

Outcome of Laparoscopic cholecystectomy among patients operated at a general hospital in a low-income country, Addis Ababa, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcome of Laparoscopic cholecystectomy among patients operated at a general hospital in a low-income country, Addis Ababa, Ethiopia Zeki Abubeker, Tebarek Jemal Hassen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8300999/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Surgery → Version 1 posted 18 You are reading this latest preprint version Abstract Background Laparoscopic cholecystectomy remains the gold standard and minimally invasive surgery for management of gallbladder disease, offering safe outcome. However, significant disparities exist across low -middle income countries. This study presents surgical outcomes of laparoscopic cholecystectomy performed at a high-volume general hospital with a hepatobiliary surgeon in Ethiopia. Methods The institutional based cross-sectional observational study was carried out at Addis Hiwot General Hospital, Addis Ababa. Based on previously published literature, a structured questionnaire was created for this study with the goal of collecting thorough data. Frequencies and percentages were used to summarize categorical variables, and the χ² test was used to compare groups. The Shapiro-Wilk test was used to evaluate the distribution of continuous variables. Means and standard deviations (SD) were reported for data that was normally distributed; medians and interquartile ranges (IQR) were used for data that was not normally distributed. Results A retrospective analysis of 424 patients who had laparoscopic cholecystectomy revealed that the female-to-male ratio was roughly 5:1, and the mean age was 42·2 years (SD 12·7). Ninety-one percent of cases involved elective procedures. In 62·0% of patients, symptomatic cholelithiasis (biliary colic) was the most common indication, followed by chronic calculous cholecystitis (22·9%). The conversion rate to open cholecystectomy was 3·5% overall. Within 30 days, 2.8% of patients experienced postoperative complications; no deaths were reported. Conclusion Despite significant inequity in access to Laparoscopic cholecystectomy, the procedure remains safe with low morbidity, conversion rate and no mortality. These findings underscore the urgent need for investment in surgical infrastructure and human resource capacity to expand access to safe laparoscopic surgery in low-resource settings. Cholithiasis cholecystectomy laparoscopy BACKGROUND Benign gallbladder disease—including cholelithiasis and choledocholithiasis—represents a growing global health burden, contributing substantially to morbidity, disability, and economic loss( 1 ). These conditions affect millions worldwide and place considerable demands on healthcare systems. Gallstone disease represents a significant global health burden, with prevalence patterns influenced by demographic, genetic, and lifestyle factors. A comprehensive meta-analysis encompassing 115 studies and a pooled sample of 32,610,568 individuals estimated the global prevalence of gallstones at 6.1% (95% CI 5.6–6.5)( 2 ). Notably, the condition was more prevalent among females than males, with rates of 7.6% and 5.4%, respectively. This sex-based disparity may reflect hormonal influences, particularly the role of estrogen in cholesterol supersaturation and gallstone formation, as well as differences in health-seeking behavior and diagnostic access( 2 ). In 2021, the global age-standardised incidence rate (ASIR) for benign gallbladder and biliary tract diseases was estimated at 870 per 100,000 population, with marked variation by sex and national development status( 1 ). Globally, an estimated 115 cholecystectomies are performed annually per 100,000 population, underscoring the widespread need for operative management of symptomatic gallstone disease and its complications. In England alone, nearly 70,000 cholecystectomies are performed each year, reflecting the scale of demand on surgical services( 3 , 4 ). In the United States, gallstone disease affects an estimated 20 million individuals, with between 300,000 and 750,000 cholecystectomies performed annually( 5 ), costing nearly 6.5 billion dollars each year( 2 ). In Europe, the annual volume of cholecystectomy procedures exceeds 900,000, reflecting the substantial burden of gallbladder disease and the widespread adoption of LC as the standard operative approach( 5 , 6 ). This burden necessitates efficient, equitable, and context-sensitive strategies for diagnosis and treatment. As health systems worldwide contend with rising case volumes, particularly in resource-constrained settings, optimizing care pathways and surgical access remains a critical priority. Laparoscopic cholecystectomy is the preferred surgical technique for the removal of a diseased gallbladder and has become the standard approach for cholecystectomy since its introduction in the early 1990s( 7 ). Compared with open surgery, the laparoscopic method offers several advantages, including reduced postoperative pain, shorter hospital stay, and faster recovery( 8 ). These benefits have led to its widespread adoption in high-resource settings and increasing uptake globally. Laparoscopic cholecystectomy is indicated in a range of benign gallbladder conditions, including acute and chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia (both hypomotility and hypermotility disorders), acalculous cholecystitis, gallstone pancreatitis, and gallbladder polyps or masses( 7 , 9 ). Patient selection is critical to ensure safety and efficacy. Contraindications to laparoscopic cholecystectomy include inability to tolerate general anesthesia or pneumoperitoneum, uncorrectable coagulopathy, and the presence of known metastatic disease( 7 ). Although laparoscopic cholecystectomy (LC) is widely regarded as a routine procedure, it can be technically demanding in certain clinical scenarios, particularly in emergency settings. Difficult LC is associated with prolonged operative time, increased intraoperative blood loss, extended hospital stay, higher complication rates, conversion to open surgery, elevated treatment costs, and, in some cases, increased mortality. Despite its clinical relevance, there is no universally accepted definition of “difficult” LC, which limits the ability of surgeons to predict its occurrence, implement preventive strategies, and anticipate outcomes. Difficult gallbladder cases are typically characterized by severe inflammation and distortion of local anatomy, which complicates dissection and increases the risk of injury( 5 ). Common pathological conditions contributing to surgical difficulty include acute calculous cholecystitis, empyema, gangrene, perforation, and Mirizzi syndrome. Some authors have proposed criteria for identifying a “bad gallbladder,” including necrosis, gangrene, perforation, Mirizzi syndrome, dense adhesions obscuring anatomical landmarks, prior tube cholecystostomy, operative duration exceeding 120 minutes, or the need for conversion to open surgery( 10 ). Reported rates of difficult LC vary, with estimates reaching up to 26% in large series( 5 ). Reported conversion rates from laparoscopic to open cholecystectomy range from 2·6% to 7·7%, primarily attributed to intraoperative difficulty associated with severe inflammation, distorted anatomy, or other complicating factors( 11 – 13 ) Surgical outcomes following laparoscopic cholecystectomy are influenced by multiple factors, including timing of surgery, American Society of Anesthesiologists (ASA) physical status classification, operative duration, and the number of prior emergency admissions for gallbladder disease. Patients typically undergo laparoscopic cholecystectomy via one of three clinical pathways: emergency cholecystectomy during an index admission for acute gallbladder pathology; elective cholecystectomy without previous emergency presentation, usually for symptomatic cholelithiasis; or delayed cholecystectomy following one or more prior emergency admissions, often after initial conservative management. A population-based prospective cohort study conducted across 167 hospitals in the UK included 8,909 patients undergoing cholecystectomy. The distribution of surgical timing was as follows: 16·3% underwent emergency cholecystectomy, 37·0% delayed cholecystectomy, and 46·8% elective cholecystectomy( 4 ). Analysis from this large, prospective cohort study revealed that the 30-day readmission rate was 7·1%, and the overall complication rate within 30 days was 10·8%( 4 ). There is a scarcity of studies evaluating the outcomes of laparoscopic surgery in Ethiopia. This study presents surgical outcomes from a high-volume hepatobiliary center in Ethiopia, contributing valuable data to this underrepresented field. METHODOLOGY Study area and period This study was conducted at the Department of surgery of Addis Hiwot General Hospital, a general hospital in Ethiopia, located in Addis Ababa, the nation's capital. The study conducted over six months from February 1/2021 to January 30/2025 Study design, sampling and sample size The institutional based cross-sectional observational study conducted at Addis Hiwot General Hospital from (AHGH) February 1/2021 to January 30/2025, aimed to assess perioperative outcomes after laparoscopic cholecystectomy for patients underwent laparoscopic cholecystectomy. The sample size was determined by using the formula for single population proportion considering a prevalence of complications after laparoscopic surgery unknow in Ethiopia, taking p 50%, calculated by assuming a Confidence interval of 95%, 5% margin of error, & 10% non-response rate. $$\:n=\frac{{\left(\frac{Za}{2}\right)}^{2.}}{{d}^{2}}p.q=\frac{{\left(1.96\right)}^{2}}{{\left(0.05\right)}^{2}}*0.5*0.5=384,\:+\hspace{0.17em}10\text{%}\:\text{n}\text{o}\text{n}-\text{r}\text{e}\text{s}\text{p}\text{o}\text{n}\text{s}\text{e}\:\text{r}\text{a}\text{t}\text{e}=422$$ Simple random sampling was used by identifying patients underwent laparoscopic surgery on each clinic visit day until the sample size is completed. Data collection procedures and analysis For this study, a structured questionnaire was developed based on previously published research and intended to collect detailed information in three areas: laboratory tests, clinical profiles, and sociodemographic traits. Before full-scale data collection began, the instrument was pretested on 5% of the intended sample population to guarantee internal consistency, clarity, and relevance. The phrasing and structure of the questions were improved based on input from the pilot phase. Secondary data was taken from electronic medical records in addition to primary data collected via the questionnaire. These records complemented and validated the self-reported data gathered during the study by offering comprehensive clinical and biochemical information about patients who had laparoscopic cholecystectomy. Categorical variables were summarized using frequencies and percentages, and comparisons between groups were performed using the χ² test. The distribution of continuous variables was assessed using the Shapiro–Wilk test. For normally distributed data, means and standard deviations (SD) were reported; for non-normally distributed data, medians and interquartile ranges (IQR) were used. Multicollinearity among categorical, continuous, and binary variables was evaluated using the variance inflation factor (VIF) and tolerance statistics. Variables with a VIF 0.1 were considered to have acceptable collinearity and were included in the multivariable ordinal logistic regression model. Variables with a VIF ≥ 5 or tolerance < 0.1 were excluded from further analysis to avoid collinearity bias. Univariate binary logistic regression was initially conducted to identify factors associated with postoperative complications. Variables with a p-value ≤ 0.25 in the univariate analysis were subsequently entered into a multivariable binary logistic regression model to determine independent associations. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, and a p-value < 0.05 was considered statistically significant RESULTS In this national study, 424 patients underwent laparoscopic cholecystectomy at a tertiary referral hospital. The mean age of participants was 42·2 years (SD 12·7), with a female-to-male ratio of approximately 5:1. Comorbidities were present in 19·1% of patients, with hypertension and diabetes mellitus being the most frequently reported conditions. Ultrasonography was the primary preoperative diagnostic modality and served as the standard imaging tool for gallbladder pathology assessment. Table 1 Table 1 : Sociodemographic and diagnostic modality of patients underwent Laparoscopic cholecystectomy at Addis Hiwot General Hospital, 2025 Item Variables Frequency Percentage Age Mean ± SD 42.2 ± 12.7 Sex Male 71 16.7 Female 353 83.3 Grade1 302 71.2 Grade2 115 27.1 Grade3 7 1.7 BMI Underweight 1 .2 Obese 1 .2 not stated 422 99.5 History of cholangitis /cholecystitis Yes 28 6.6 No 396 93.4 Comorbidity HTN 35 8.3 DM 23 5.4 CKD 1 .2 COPD 3 .7 HTN and DM 13 3.1 Others (hyper/hypothyroidism, BPH, RVI.) 4 .9 HTN and COPD 1 .2 DM and COPD 1 .2 None 343 80.9 Preop image Ultrasound 422 99.5 Others (U/S & MRCP, EUS, ERCP) 1 .2 Ultrasound and therapeutic ERCP 1 .2 Image report Gallstones 351 82.8 thick-walled gallbladder 6 1.4 CBD stone 2 .5 dilated CBD 1 .2 polyp(s) 12 2.8 gallstone, thick wall, pericholecystic fluid 21 5.0 gallstone, thick wall 21 5.0 thick wall, pericholecystic fluid 1 .2 Adenomyomatosis 1 .2 Gallstone, Dilated CBD and Stone 5 1.2 Gallstone and Polyp 3 .7 Of the patients included in the analysis, 91·7% underwent elective laparoscopic cholecystectomy, while 8·3% underwent emergency procedures. The most common indications for surgery were symptomatic cholelithiasis (biliary colic), accounting for 62·0% of cases, followed by chronic calculous cholecystitis (22·9%) and gallbladder polyps (2·6%). The critical view of safety (CVS) was successfully achieved in 96·5% of procedures. The overall conversion rate from laparoscopic to open cholecystectomy was 3·5%, with the primary intraoperative reasons being dense adhesions, haemodynamic instability, intraoperative bleeding, and suspected common bile duct stones. Table 2 Indications of laparoscopic surgery at Addis Hiwot General Hospital Ethiopia, 2025 Item Response Frequency Percentage Antibiotics Prophylactic 389 91.7 Therapeutic 35 8.3 Time of surgery Elective 389 91.7 Emergency 35 8.3 Indications acute calculus cholecystitis 34 8.0 biliary colic 263 62.0 Acalculous cholecystitis 3 .7 chronic calculus cholecystitis 97 22.9 gallbladder polyp 11 2.6 gallstone pancreatitis 1 .2 GB Hydrops 5 1.2 GB Empyema 3 .7 GB stone - post ERCP for CBD stone 7 1.7 Approach Laparoscopic 409 96.5 Open conversion 15 3.5 Reasons Bleeding 2 .5 Adhesion 11 2.6 hemodynamic instability 1 .2 Suspected CBD stone 1 .2 CVS obtained Yes 409 96.5 No 15 3.5 Drain Yes 16 3.8 No 408 96.2 Biliovascular variant Yes 3 .7 No 421 99.3 Among patients undergoing laparoscopic cholecystectomy (LC), the vast majority (99.3%) were classified as having clean-contaminated surgical wounds. Intraoperative events included bile spillage in 4.5% of cases and intraoperative bleeding in 2.8%. Postoperative outcomes were favorable, with 97.2% of patients experiencing no complications. The overall 30-day postoperative complication rate was 2.8%, with most complications classified as minor. The duration of hospital stay was notably short, with a mean length of stay of 21.0 hours (SD 9.7), and the majority of patients discharged within 24 hours of surgery. These findings reflect the efficiency and safety of LC in this tertiary referral setting Table 3 Management outcome after laparoscopic cholecystectomy at Addis Hiwot General Hospital, Ethiopia 2025 Item Response Frequency Percentage Operative contaminations clean contaminated 421 99.3 Contaminated 3 .7 IOC bile spillage 19 4.5 Bleeding 12 2.8 bleeding and bile spillage 1 .2 None 392 92.5 Clavien Dindo 30-day complication grade No complication 412 97.2 Grade1 9 2.1 Grade2 3 0.7 Unplanned reimage Yes 44 10.4 No 380 89.6 Unplanned admission Yes 7 1.7 No 417 98.3 Postoperative complications Surgical site infection 3 .7 Pulmonary complication 1 .2 Bile leak 1 .2 Others 7 1.7 None 412 97.2 Specimen sent for histopathology exam (HPE) Yes 27 6.4 No 397 93.6 Indication mass/wall thickening/ found incidentally 7 1.7 Polyp on preop imaging 16 3.8 Asymmetric wall thickening on imaging 3 .7 others(suspicion of TB, ..) 1 .2 LOH (hours) Mean ± SD 21 ± 9.7 Discussion This study represents one of the largest investigations into the outcomes of laparoscopic cholecystectomy (LC) in Ethiopia, providing valuable insights into patient demographics and surgical trends within a major national referral center. The median age of patients undergoing LC was in the fourth decade of life, consistent with the known epidemiology of gallstone disease, which typically manifests in middle age due to cumulative metabolic and hormonal factors( 14 ). A notable finding was the predominance of female patients, with a female-to-male ratio of approximately 5:1. The age and sex distribution observed in this study was consistent with findings from previous research conducted in Ethiopia( 15 ). However, this sex distribution exceeds that reported in high-income settings. For example, a large multicenter study conducted in the UK involving 8,909 patients across 167 hospitals documented a female-to-male ratio of approximately 3:1( 4 ). The observed discrepancy may be attributed to a combination of geographic, socioeconomic, and behavioural factors. In Ethiopia, differences in health-seeking behaviors, cultural norms, and access to diagnostic services may contribute to delayed presentation among male patients or underreporting of symptoms. Additionally, hormonal influences—particularly the role of estrogen in cholesterol metabolism—may further explain the higher prevalence of gallstone disease among women. These findings underscore the importance of context-specific data in understanding surgical disease patterns and highlight the need for gender-sensitive approaches in surgical planning and public health outreach. Further research is warranted to explore the underlying drivers of these demographic differences and to assess whether similar trends are observed across other surgical conditions in low-resource settings. Laparoscopic cholecystectomy (LC) can be categorized into three clinical pathways: elective cholecystectomy performed without prior emergency admission, emergency cholecystectomy conducted during an initial acute presentation, and delayed cholecystectomy following one or more previous emergency admissions related to gallbladder pathology. In our study, the majority of patients (91·7%) underwent elective LC, while only 8·3% received surgery during an emergency admission. This distribution contrasts with findings from a large multicenter study in the UK, which reported that 46·8% of cholecystectomies were elective, 37·0% were delayed following prior emergency admissions, and 16·3% were performed as emergency procedures( 4 ). Additionally, a large global prospective study involving 21,706 surgical patients across 57 countries reported that cholecystectomies were performed in elective (49·9%), emergency (19·7%), and delayed (30·5%) settings( 16 ). The lower proportion of emergency and delayed procedures in our cohort may reflect difference in adoptability in global recommendations, surgical expertise, surgical scheduling capacity, and thresholds for operative intervention in resource-limited settings. The predominance of elective procedures in our setting could also indicate a more conservative approach to acute gallbladder disease, possibly due to limited availability of emergency theatre time, anaesthetic support, or surgical expertise during off-hours. Conversely, the relatively low rate of delayed cholecystectomy may suggest under-recognition or under-documentation of prior emergency presentations, or barriers to timely follow-up after initial non-operative management. Another key quality indicator in laparoscopic cholecystectomy (LC) is the rate of conversion to open cholecystectomy. Conversion is typically necessitated by intraoperative challenges such as dense adhesions, unclear anatomy, or complications that compromise the safety of continuing laparoscopically. While these factors are often patient-related, the level of surgical expertise and institutional experience also play a critical role in determining the likelihood of conversion. In our study, the conversion rate to open cholecystectomy was 3.5%, which aligns closely with international benchmarks. A large multicenter study conducted in the UK( 4 ) reported a conversion rate of 3.3%, while a study from South Africa( 14 ) documented a slightly higher rate of 5.4%. These figures suggest that, despite resource limitations, the surgical outcomes in our setting are comparable to those in more developed health systems, particularly when procedures are performed in high-volume tertiary centres. The observed conversion rate in our cohort may reflect both the complexity of cases referred to national referral hospitals and the evolving proficiency of surgical teams in Ethiopia. Continued investment in laparoscopic training, mentorship, and infrastructure is essential to further reduce conversion rates and enhance the safety and efficiency of minimally invasive surgery in low-resource setting Laparoscopic cholecystectomy (LC) is widely recognized as the standard surgical approach for managing gallbladder pathology, offering substantial benefits over open techniques—including reduced postoperative pain, shorter hospital stays, and improved quality of life. However, despite its minimally invasive nature, LC is not without risk, and postoperative complications remain an important metric of surgical quality and safety. In our study, the overall postoperative complication rate was 2.8%, with the majority classified as Clavien–Dindo grade I, indicating minor complications requiring minimal intervention. This rate is notably lower than those reported in comparable studies from other regions. For instance, a study conducted in South Africa documented a complication rate of 16.2%, with bile duct injuries and bile leaks occurring in 1.2% and 1.8% of cases, respectively. Similarly, Radunovic et al. (2005–2014) reported a complication rate of 13.1% among 740 patients, alongside a conversion rate of 3.91% and a bile duct injury rate of 1.89%, with no mortality observed. A large multicenter study in the UK further highlighted the burden of postoperative morbidity, reporting 30-day readmission and complication rates of 7.1% and 10.8%, respectively( 4 ). A meta-analysis of 151 studies encompassing over 505,000 individuals reported that laparoscopic cholecystectomy is a safe procedure, associated with low morbidity (pooled prevalence range 1·6–5·3%) and mortality (0·08–0·14%). The conversion rate to open cholecystectomy ranged between 4·2% and 6·2%, further supporting the procedure’s reliability and safety across diverse clinical settings( 17 ). Additionally, a large global prospective study involving 21,706 surgical patients across 57 countries reported a 30-day postoperative complication rate of 8·0%, including a mortality rate of 0·4%. Bile leaks (Strasberg grade A) occurred in 1·3% of patients, while severe bile duct injuries (Strasberg grades B–E) were reported in 0·2%( 16 ). The comparatively lower complication rate observed in our cohort may reflect young, low ASA risk patients and dominantly the elective procedures. Nonetheless, the presence of even minor complications underscores the need for continued vigilance, surgical training, and postoperative monitoring to ensure optimal outcomes. These findings contribute to the growing body of evidence supporting the safety and efficacy of LC in low-resource settings and reinforce the importance of context-specific data to guide surgical practice and policy. In conclusion, despite persistent inequities in access to laparoscopic surgery in Ethiopia, the procedure remains safe, with low morbidity, a low conversion rate to open surgery, and no associated mortality. Abbreviations CBD Common Bile Duct HICs high-income countries LC Laparoscopic cholecystectomy LMICs Low- and Middle-Income Countries UK United Kingdom Declarations Ethical approval and consent participants The ethical approval was obtained the Institutional Review Board, ethical review committees of the Department of surgery, Addis Hiwot General Hospital from (AHGH). The study adhered with Declaration of Helsinki. Written informed consent was not obtained from participants due to institutional approval and the study's retrospective nature. Fundings: No funding given for this study Consent for publication: Not applicable Clinical Trial Registration : Not applicable Confilict of interest: Authors declare that they have no competing interests. Author contributions: Conceptualization: ZA; Data collection and analysis: ZA and TJ Manuscript writing: ZA and TJ; Manuscript review , editing and approval: ZA and TJ Availability of data and materials The datasets used and/or analyzed during the current study are available from corresponding authors on reasonable request. Acknowledgements The authors would like to thank the OR and administrative staff of Addis Hiwot General Hospital References Tian JLL, Tian S, Liu Y, Hu X, Wang Y, Wang Y, Lan H, Mackay LE, Shiferaw BD, Yan N, Wang Y, Luo Y, Li L, Wang W. Global, Regional, National Burden of Gallbladder and Biliary Diseases From 1990 to 2021 and Forecasted Trends by 2040. Liver Int. 2025;45(5):e70103. 10.1111/liv.70103 . PMID: 40287816. Wang XYW, Jiang G, Li H, Li S, Xie L, Bai X, Cui P, Chen Q, Lou Y, Zou L, Li S, Zhou Z, Zhang C, Sun P, Mao M. Global Epidemiology of Gallstones in the 21st Century: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2024;22(8):1586–95. Epub 2024 Feb 19. PMID: 38382725. Sinha SHD, Stoker DL, Friend PJ, Poloniecki JD, Thompson MM, et al. Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics. Surg Endosc. 2013;27:162–75. Choles study group WMRC. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg. 2016;103:1704–15. Abdallah HSSM, Sedky ZH. The difficult laparoscopic cholecystectomy: a narrative review. BMC Surg. 2025;25(1):156. 10.1186/s12893-025-02847-3 . PMID: 40221716; PMCID: PMC11992859. Aerts RPF. The burden of gallstone disease in Europe. Aliment Pharmacol Ther. 2003;18(Suppl 3):49–53. Asad UWC, Jones MW, Laparoscopic Cholecystectomy. [Updated 2025 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448145/ Keus F, dJJ, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;(4):CD006231. 10.1002/14651858.CD006231 . PMID: 17054285. Lucocq JSJ, Patil P. Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy. Surg Endosc. 2022;36:6403–9. Ashfaq AAK, Shah AA, Chapital AB, Harold KL, Johnson DJ. The difficult gall bladder: outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg. 2016;212(6):1261–4. Ballal MDG, Willmott S, Corless DJ, Deakin M, Slavin JP. Conversion after laparoscopic cholecystectomy in England. Surg Endosc. 2009;23:2338–44. 10.1007/s00464-009-0338-1 . Zhang WJLJ, Wu GZ, Luo KL, Dong ZT. Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy. Anz J Surg. 2008;78:973–6. 10.1111/j.1445-2197.2008.04714.x . Taki-Eldin A, Badawy AE, OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN, PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL. Arq Bras Cir Dig. 2018;31(1):e1347. 10.1590/0102-672020180001e1347 . PMID: 29947681; PMCID: PMC6049991. MBATHA SZA F. Sept. Outcomes in laparoscopic cholecystectomy in a resource constrained environment. S. Afr. j. surg., Cape Town, v. 54, n. 3, pp. 8–12, 2016. Available from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612016000300003&lng=en&nrm=iso >. access on 04 Nov. 2025. Hana Abebe MB, TRENDS AND OUTCOMES, OF CHOLECYSTECTOMY; A COMPARATIVE STUDY OF OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY, Ethiop Med J. 2021, 59, No. 1. Wong GYMWH, Roth Cardoso V, Bravo Merodio L, Rajeev Y, Maldonado RD, Martinino A, Balasubaramaniam V, Ashraf A, Siddiqui A, Al-Shkirat AG, Mohammed Abu-Elfatth A, Gupta A, Alkaseek A, Ouyahia A, Said A, Pandey A, Kumar A, Maqbool B, Millán CA, Singh C, Pantoja Pachajoa DA, Adamovich DM, Petracchi E, Ashraf F, Clementi M, Mulita F, Marom GA, Abdulaal G, Verras GI, Calini G, Moretto G, Elfeki H, Liang H, Jalaawiy H, Elzayat I, Das JK, Aceves-Ayala JM, Ahmed KT, Degrate L, Aggarwal M, Omar MA, Rais M, Elhadi M, Sakran N, Bhojwani R, Agarwalla R, Kanaan S, Erdene S, Chooklin S, Khuroo S, Dawani S, Asghar ST, Fung TKJ, Omarov T, Grigorean VT, Boras Z, Gkoutos V, Singhal G, Mahawar R. AMBROSE Collaborative. 30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study. Ann Surg. 2025;281(2):312–21. 10.1097/SLA.0000000000006236 . Epub 2024 Feb 13. PMID: 38348652; PMCID: PMC11723498. Pucher PHBL, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R, SAGES Safe Cholecystectomy Task Force. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175–83. 10.1007/s00464-017-5974-2 . Epub 2018 Mar 19. PMID: 29556977; PMCID: PMC5897463. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Feb, 2026 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 09 Jan, 2026 Reviews received at journal 09 Jan, 2026 Reviews received at journal 29 Dec, 2025 Reviewers agreed at journal 25 Dec, 2025 Reviews received at journal 24 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 18 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 16 Dec, 2025 Editor invited by journal 16 Dec, 2025 Editor assigned by journal 12 Dec, 2025 Submission checks completed at journal 12 Dec, 2025 First submitted to journal 07 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8300999","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":562052353,"identity":"065e2df9-0da2-4739-b2c8-3c6230a859e5","order_by":0,"name":"Zeki Abubeker","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3PsQrCMBCA4UggXU7qeKLYV1AKVfBlKkJc0jfQOgi6iK4dfAinTg6BYnyF7kIFcRAKjmIVXdu6CeYfjgz3QY4Qne4nY58HldnA5jeEuU8C3xBov2YhsBZqmFZ3k1Y3EOk5HveAGNF+m0cqS64akBzsZuyFfaGyjwHncR6hZDSnINUgQC+0BcsIgpNLmHmapRmZBigSW9xLEEAuGyDHLqKgR29egiAmvL6RshNA4lBvhcCKbrHW3L5epG+hMTym4ua3TCNSueRdREjNZfi6rsT6M58QU9JryW2dTqf7sx78D0RrLwCCnwAAAABJRU5ErkJggg==","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Zeki","middleName":"","lastName":"Abubeker","suffix":""},{"id":562052361,"identity":"cc16b85f-ecf0-4062-9309-1164800f059e","order_by":1,"name":"Tebarek Jemal Hassen","email":"","orcid":"","institution":"Yirgalem Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tebarek","middleName":"Jemal","lastName":"Hassen","suffix":""}],"badges":[],"createdAt":"2025-12-07 16:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8300999/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8300999/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-026-03625-5","type":"published","date":"2026-02-23T15:58:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98606596,"identity":"de76794c-c613-42ba-9e24-b204f737f5df","added_by":"auto","created_at":"2025-12-19 13:43:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":52210,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscripLapascopiccholecystectomyRevised.docx","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/05bbd6f9fb88a44f386af97a.docx"},{"id":98628937,"identity":"973923fd-4946-49ba-a10f-93a235a9423d","added_by":"auto","created_at":"2025-12-19 17:12:50","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4846,"visible":true,"origin":"","legend":"","description":"","filename":"aa567600ac5643c8823b51148d7ffeb3.json","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/1f55f48c6183b530862f6ee8.json"},{"id":98606597,"identity":"97728f1f-f685-4908-89a1-7c2c301f9dc2","added_by":"auto","created_at":"2025-12-19 13:43:47","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89198,"visible":true,"origin":"","legend":"","description":"","filename":"aa567600ac5643c8823b51148d7ffeb31enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/e3b3389b5ca9c04912541a68.xml"},{"id":98606599,"identity":"8520204f-5415-4530-aad5-3a0d0904e692","added_by":"auto","created_at":"2025-12-19 13:43:47","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87894,"visible":true,"origin":"","legend":"","description":"","filename":"aa567600ac5643c8823b51148d7ffeb31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/f66c22ba3185d4f3183f9e79.xml"},{"id":98606600,"identity":"390dc73a-a2d8-418f-a6b3-9615ece8eb16","added_by":"auto","created_at":"2025-12-19 13:43:47","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94222,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/2a3337880452f82931f5c7df.html"},{"id":103765746,"identity":"379439b0-7b45-4a96-b801-adcf96efccf3","added_by":"auto","created_at":"2026-03-02 16:08:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":606733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8300999/v1/cf967df5-78e1-48cd-9f1e-ee0897addf97.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcome of Laparoscopic cholecystectomy among patients operated at a general hospital in a low-income country, Addis Ababa, Ethiopia","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eBenign gallbladder disease—including cholelithiasis and choledocholithiasis—represents a growing global health burden, contributing substantially to morbidity, disability, and economic loss(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These conditions affect millions worldwide and place considerable demands on healthcare systems. Gallstone disease represents a significant global health burden, with prevalence patterns influenced by demographic, genetic, and lifestyle factors. A comprehensive meta-analysis encompassing 115 studies and a pooled sample of 32,610,568 individuals estimated the global prevalence of gallstones at 6.1% (95% CI 5.6–6.5)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Notably, the condition was more prevalent among females than males, with rates of 7.6% and 5.4%, respectively. This sex-based disparity may reflect hormonal influences, particularly the role of estrogen in cholesterol supersaturation and gallstone formation, as well as differences in health-seeking behavior and diagnostic access(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In 2021, the global age-standardised incidence rate (ASIR) for benign gallbladder and biliary tract diseases was estimated at 870 per 100,000 population, with marked variation by sex and national development status(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Globally, an estimated 115 cholecystectomies are performed annually per 100,000 population, underscoring the widespread need for operative management of symptomatic gallstone disease and its complications. In England alone, nearly 70,000 cholecystectomies are performed each year, reflecting the scale of demand on surgical services(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In the United States, gallstone disease affects an estimated 20\u0026nbsp;million individuals, with between 300,000 and 750,000 cholecystectomies performed annually(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), costing nearly 6.5\u0026nbsp;billion dollars each year(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Europe, the annual volume of cholecystectomy procedures exceeds 900,000, reflecting the substantial burden of gallbladder disease and the widespread adoption of LC as the standard operative approach(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This burden necessitates efficient, equitable, and context-sensitive strategies for diagnosis and treatment. As health systems worldwide contend with rising case volumes, particularly in resource-constrained settings, optimizing care pathways and surgical access remains a critical priority.\u003c/p\u003e \u003cp\u003eLaparoscopic cholecystectomy is the preferred surgical technique for the removal of a diseased gallbladder and has become the standard approach for cholecystectomy since its introduction in the early 1990s(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Compared with open surgery, the laparoscopic method offers several advantages, including reduced postoperative pain, shorter hospital stay, and faster recovery(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These benefits have led to its widespread adoption in high-resource settings and increasing uptake globally. Laparoscopic cholecystectomy is indicated in a range of benign gallbladder conditions, including acute and chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia (both hypomotility and hypermotility disorders), acalculous cholecystitis, gallstone pancreatitis, and gallbladder polyps or masses(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Patient selection is critical to ensure safety and efficacy. Contraindications to laparoscopic cholecystectomy include inability to tolerate general anesthesia or pneumoperitoneum, uncorrectable coagulopathy, and the presence of known metastatic disease(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough laparoscopic cholecystectomy (LC) is widely regarded as a routine procedure, it can be technically demanding in certain clinical scenarios, particularly in emergency settings. Difficult LC is associated with prolonged operative time, increased intraoperative blood loss, extended hospital stay, higher complication rates, conversion to open surgery, elevated treatment costs, and, in some cases, increased mortality. Despite its clinical relevance, there is no universally accepted definition of “difficult” LC, which limits the ability of surgeons to predict its occurrence, implement preventive strategies, and anticipate outcomes. Difficult gallbladder cases are typically characterized by severe inflammation and distortion of local anatomy, which complicates dissection and increases the risk of injury(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Common pathological conditions contributing to surgical difficulty include acute calculous cholecystitis, empyema, gangrene, perforation, and Mirizzi syndrome. Some authors have proposed criteria for identifying a “bad gallbladder,” including necrosis, gangrene, perforation, Mirizzi syndrome, dense adhesions obscuring anatomical landmarks, prior tube cholecystostomy, operative duration exceeding 120 minutes, or the need for conversion to open surgery(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Reported rates of difficult LC vary, with estimates reaching up to 26% in large series(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Reported conversion rates from laparoscopic to open cholecystectomy range from 2·6% to 7·7%, primarily attributed to intraoperative difficulty associated with severe inflammation, distorted anatomy, or other complicating factors(\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSurgical outcomes following laparoscopic cholecystectomy are influenced by multiple factors, including timing of surgery, American Society of Anesthesiologists (ASA) physical status classification, operative duration, and the number of prior emergency admissions for gallbladder disease. Patients typically undergo laparoscopic cholecystectomy via one of three clinical pathways: emergency cholecystectomy during an index admission for acute gallbladder pathology; elective cholecystectomy without previous emergency presentation, usually for symptomatic cholelithiasis; or delayed cholecystectomy following one or more prior emergency admissions, often after initial conservative management. A population-based prospective cohort study conducted across 167 hospitals in the UK included 8,909 patients undergoing cholecystectomy. The distribution of surgical timing was as follows: 16·3% underwent emergency cholecystectomy, 37·0% delayed cholecystectomy, and 46·8% elective cholecystectomy(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Analysis from this large, prospective cohort study revealed that the 30-day readmission rate was 7·1%, and the overall complication rate within 30 days was 10·8%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a scarcity of studies evaluating the outcomes of laparoscopic surgery in Ethiopia. This study presents surgical outcomes from a high-volume hepatobiliary center in Ethiopia, contributing valuable data to this underrepresented field.\u003c/p\u003e "},{"header":"METHODOLOGY","content":"\u003cp\u003eStudy area and period\u003c/p\u003e\u003cp\u003eThis study was conducted at the Department of surgery of Addis Hiwot General Hospital, a general hospital in Ethiopia, located in Addis Ababa, the nation's capital. The study conducted over six months from February 1/2021 to January 30/2025\u003c/p\u003e\u003cp\u003eStudy design, sampling and sample size\u003c/p\u003e\u003cp\u003eThe institutional based cross-sectional observational study conducted at Addis Hiwot General Hospital from (AHGH) February 1/2021 to January 30/2025, aimed to assess perioperative outcomes after laparoscopic cholecystectomy for \u003cem\u003epatients underwent laparoscopic cholecystectomy.\u003c/em\u003e The sample size was determined by using the formula for single population proportion considering a prevalence of complications after laparoscopic surgery unknow in Ethiopia, taking p 50%, calculated by assuming a Confidence interval of 95%, 5% margin of error, \u0026amp; 10% non-response rate.\u003c/p\u003e\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{\\left(\\frac{Za}{2}\\right)}^{2.}}{{d}^{2}}p.q=\\frac{{\\left(1.96\\right)}^{2}}{{\\left(0.05\\right)}^{2}}*0.5*0.5=384,\\:+\\hspace{0.17em}10\\text{%}\\:\\text{n}\\text{o}\\text{n}-\\text{r}\\text{e}\\text{s}\\text{p}\\text{o}\\text{n}\\text{s}\\text{e}\\:\\text{r}\\text{a}\\text{t}\\text{e}=422$$\u003c/div\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSimple random sampling was used by identifying patients underwent laparoscopic surgery on each clinic visit day until the sample size is completed.\u003c/p\u003e\u003cp\u003eData collection procedures and analysis\u003c/p\u003e\u003cp\u003eFor this study, a structured questionnaire was developed based on previously published research and intended to collect detailed information in three areas: laboratory tests, clinical profiles, and sociodemographic traits. Before full-scale data collection began, the instrument was pretested on 5% of the intended sample population to guarantee internal consistency, clarity, and relevance. The phrasing and structure of the questions were improved based on input from the pilot phase. Secondary data was taken from electronic medical records in addition to primary data collected via the questionnaire. These records complemented and validated the self-reported data gathered during the study by offering comprehensive clinical and biochemical information about patients who had laparoscopic cholecystectomy.\u003c/p\u003e\u003cp\u003eCategorical variables were summarized using frequencies and percentages, and comparisons between groups were performed using the χ² test. The distribution of continuous variables was assessed using the Shapiro–Wilk test. For normally distributed data, means and standard deviations (SD) were reported; for non-normally distributed data, medians and interquartile ranges (IQR) were used. Multicollinearity among categorical, continuous, and binary variables was evaluated using the variance inflation factor (VIF) and tolerance statistics. Variables with a VIF \u0026lt; 5 and tolerance \u0026gt; 0.1 were considered to have acceptable collinearity and were included in the multivariable ordinal logistic regression model. Variables with a VIF ≥ 5 or tolerance \u0026lt; 0.1 were excluded from further analysis to avoid collinearity bias. Univariate binary logistic regression was initially conducted to identify factors associated with postoperative complications. Variables with a p-value ≤ 0.25 in the univariate analysis were subsequently entered into a multivariable binary logistic regression model to determine independent associations. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, and a p-value \u0026lt; 0.05 was considered statistically significant\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn this national study, 424 patients underwent laparoscopic cholecystectomy at a tertiary referral hospital. The mean age of participants was 42\u0026middot;2 years (SD 12\u0026middot;7), with a female-to-male ratio of approximately 5:1. Comorbidities were present in 19\u0026middot;1% of patients, with hypertension and diabetes mellitus being the most frequently reported conditions. Ultrasonography was the primary preoperative diagnostic modality and served as the standard imaging tool for gallbladder pathology assessment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Sociodemographic and diagnostic modality of patients underwent Laparoscopic cholecystectomy at Addis Hiwot General Hospital, 2025\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enot stated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of cholangitis /cholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN and DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (hyper/hypothyroidism, BPH, RVI.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN and COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDM and COPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePreop image\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (U/S \u0026amp; MRCP, EUS, ERCP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound and therapeutic ERCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eImage report\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGallstones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethick-walled gallbladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCBD stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edilated CBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epolyp(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egallstone, thick wall, pericholecystic fluid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egallstone, thick wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethick wall, pericholecystic fluid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdenomyomatosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGallstone, Dilated CBD and Stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGallstone and Polyp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the patients included in the analysis, 91\u0026middot;7% underwent elective laparoscopic cholecystectomy, while 8\u0026middot;3% underwent emergency procedures. The most common indications for surgery were symptomatic cholelithiasis (biliary colic), accounting for 62\u0026middot;0% of cases, followed by chronic calculous cholecystitis (22\u0026middot;9%) and gallbladder polyps (2\u0026middot;6%). The critical view of safety (CVS) was successfully achieved in 96\u0026middot;5% of procedures. The overall conversion rate from laparoscopic to open cholecystectomy was 3\u0026middot;5%, with the primary intraoperative reasons being dense adhesions, haemodynamic instability, intraoperative bleeding, and suspected common bile duct stones.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndications of laparoscopic surgery at Addis Hiwot General Hospital Ethiopia, 2025\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProphylactic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTherapeutic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eIndications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eacute calculus cholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebiliary colic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcalculous cholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003echronic calculus cholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egallbladder polyp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egallstone pancreatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGB Hydrops\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGB Empyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGB stone - post ERCP for CBD stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eApproach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen conversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdhesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehemodynamic instability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuspected CBD stone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCVS obtained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBiliovascular variant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong patients undergoing laparoscopic cholecystectomy (LC), the vast majority (99.3%) were classified as having clean-contaminated surgical wounds. Intraoperative events included bile spillage in 4.5% of cases and intraoperative bleeding in 2.8%. Postoperative outcomes were favorable, with 97.2% of patients experiencing no complications. The overall 30-day postoperative complication rate was 2.8%, with most complications classified as minor. The duration of hospital stay was notably short, with a mean length of stay of 21.0 hours (SD 9.7), and the majority of patients discharged within 24 hours of surgery. These findings reflect the efficiency and safety of LC in this tertiary referral setting\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eManagement outcome after laparoscopic cholecystectomy at Addis Hiwot General Hospital, Ethiopia 2025\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOperative contaminations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eclean contaminated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContaminated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebile spillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebleeding and bile spillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClavien Dindo 30-day complication grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnplanned reimage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnplanned admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBile leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSpecimen sent for histopathology exam (HPE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIndication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emass/wall thickening/ found incidentally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolyp on preop imaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsymmetric wall thickening on imaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers(suspicion of TB, ..)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLOH (hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents one of the largest investigations into the outcomes of laparoscopic cholecystectomy (LC) in Ethiopia, providing valuable insights into patient demographics and surgical trends within a major national referral center. The median age of patients undergoing LC was in the fourth decade of life, consistent with the known epidemiology of gallstone disease, which typically manifests in middle age due to cumulative metabolic and hormonal factors(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A notable finding was the predominance of female patients, with a female-to-male ratio of approximately 5:1. The age and sex distribution observed in this study was consistent with findings from previous research conducted in Ethiopia(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, this sex distribution exceeds that reported in high-income settings. For example, a large multicenter study conducted in the UK involving 8,909 patients across 167 hospitals documented a female-to-male ratio of approximately 3:1(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The observed discrepancy may be attributed to a combination of geographic, socioeconomic, and behavioural factors. In Ethiopia, differences in health-seeking behaviors, cultural norms, and access to diagnostic services may contribute to delayed presentation among male patients or underreporting of symptoms. Additionally, hormonal influences\u0026mdash;particularly the role of estrogen in cholesterol metabolism\u0026mdash;may further explain the higher prevalence of gallstone disease among women. These findings underscore the importance of context-specific data in understanding surgical disease patterns and highlight the need for gender-sensitive approaches in surgical planning and public health outreach. Further research is warranted to explore the underlying drivers of these demographic differences and to assess whether similar trends are observed across other surgical conditions in low-resource settings.\u003c/p\u003e \u003cp\u003eLaparoscopic cholecystectomy (LC) can be categorized into three clinical pathways: elective cholecystectomy performed without prior emergency admission, emergency cholecystectomy conducted during an initial acute presentation, and delayed cholecystectomy following one or more previous emergency admissions related to gallbladder pathology. In our study, the majority of patients (91\u0026middot;7%) underwent elective LC, while only 8\u0026middot;3% received surgery during an emergency admission. This distribution contrasts with findings from a large multicenter study in the UK, which reported that 46\u0026middot;8% of cholecystectomies were elective, 37\u0026middot;0% were delayed following prior emergency admissions, and 16\u0026middot;3% were performed as emergency procedures(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additionally, a large global prospective study involving 21,706 surgical patients across 57 countries reported that cholecystectomies were performed in elective (49\u0026middot;9%), emergency (19\u0026middot;7%), and delayed (30\u0026middot;5%) settings(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The lower proportion of emergency and delayed procedures in our cohort may reflect difference in adoptability in global recommendations, surgical expertise, surgical scheduling capacity, and thresholds for operative intervention in resource-limited settings. The predominance of elective procedures in our setting could also indicate a more conservative approach to acute gallbladder disease, possibly due to limited availability of emergency theatre time, anaesthetic support, or surgical expertise during off-hours. Conversely, the relatively low rate of delayed cholecystectomy may suggest under-recognition or under-documentation of prior emergency presentations, or barriers to timely follow-up after initial non-operative management.\u003c/p\u003e \u003cp\u003eAnother key quality indicator in laparoscopic cholecystectomy (LC) is the rate of conversion to open cholecystectomy. Conversion is typically necessitated by intraoperative challenges such as dense adhesions, unclear anatomy, or complications that compromise the safety of continuing laparoscopically. While these factors are often patient-related, the level of surgical expertise and institutional experience also play a critical role in determining the likelihood of conversion. In our study, the conversion rate to open cholecystectomy was 3.5%, which aligns closely with international benchmarks. A large multicenter study conducted in the UK(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) reported a conversion rate of 3.3%, while a study from South Africa(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) documented a slightly higher rate of 5.4%. These figures suggest that, despite resource limitations, the surgical outcomes in our setting are comparable to those in more developed health systems, particularly when procedures are performed in high-volume tertiary centres. The observed conversion rate in our cohort may reflect both the complexity of cases referred to national referral hospitals and the evolving proficiency of surgical teams in Ethiopia. Continued investment in laparoscopic training, mentorship, and infrastructure is essential to further reduce conversion rates and enhance the safety and efficiency of minimally invasive surgery in low-resource setting\u003c/p\u003e \u003cp\u003eLaparoscopic cholecystectomy (LC) is widely recognized as the standard surgical approach for managing gallbladder pathology, offering substantial benefits over open techniques\u0026mdash;including reduced postoperative pain, shorter hospital stays, and improved quality of life. However, despite its minimally invasive nature, LC is not without risk, and postoperative complications remain an important metric of surgical quality and safety. In our study, the overall postoperative complication rate was 2.8%, with the majority classified as Clavien\u0026ndash;Dindo grade I, indicating minor complications requiring minimal intervention. This rate is notably lower than those reported in comparable studies from other regions. For instance, a study conducted in South Africa documented a complication rate of 16.2%, with bile duct injuries and bile leaks occurring in 1.2% and 1.8% of cases, respectively. Similarly, Radunovic et al. (2005\u0026ndash;2014) reported a complication rate of 13.1% among 740 patients, alongside a conversion rate of 3.91% and a bile duct injury rate of 1.89%, with no mortality observed. A large multicenter study in the UK further highlighted the burden of postoperative morbidity, reporting 30-day readmission and complication rates of 7.1% and 10.8%, respectively(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A meta-analysis of 151 studies encompassing over 505,000 individuals reported that laparoscopic cholecystectomy is a safe procedure, associated with low morbidity (pooled prevalence range 1\u0026middot;6\u0026ndash;5\u0026middot;3%) and mortality (0\u0026middot;08\u0026ndash;0\u0026middot;14%). The conversion rate to open cholecystectomy ranged between 4\u0026middot;2% and 6\u0026middot;2%, further supporting the procedure\u0026rsquo;s reliability and safety across diverse clinical settings(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, a large global prospective study involving 21,706 surgical patients across 57 countries reported a 30-day postoperative complication rate of 8\u0026middot;0%, including a mortality rate of 0\u0026middot;4%. Bile leaks (Strasberg grade A) occurred in 1\u0026middot;3% of patients, while severe bile duct injuries (Strasberg grades B\u0026ndash;E) were reported in 0\u0026middot;2%(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The comparatively lower complication rate observed in our cohort may reflect young, low ASA risk patients and dominantly the elective procedures. Nonetheless, the presence of even minor complications underscores the need for continued vigilance, surgical training, and postoperative monitoring to ensure optimal outcomes. These findings contribute to the growing body of evidence supporting the safety and efficacy of LC in low-resource settings and reinforce the importance of context-specific data to guide surgical practice and policy.\u003c/p\u003e \u003cp\u003eIn conclusion, despite persistent inequities in access to laparoscopic surgery in Ethiopia, the procedure remains safe, with low morbidity, a low conversion rate to open surgery, and no associated mortality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eCBD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eCommon Bile Duct\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eHICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003ehigh-income countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eLC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eLaparoscopic cholecystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eLMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eLow- and Middle-Income Countries\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eUnited Kingdom\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe ethical approval was obtained the Institutional Review Board, ethical review committees of the Department of surgery, Addis Hiwot General Hospital from (AHGH). The study adhered with\u0026nbsp;Declaration of Helsinki. Written informed consent was not obtained from participants due to institutional approval and the study's retrospective nature.\u003c/p\u003e\n\u003cp\u003eFundings: No funding given for this study\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003eClinical Trial Registration : Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConfilict of interest:\u0026nbsp;Authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor contributions: \u0026nbsp;Conceptualization: \u0026nbsp;ZA;\u0026nbsp;Data collection and analysis: ZA and TJ\u003c/p\u003e\n\u003cp\u003eManuscript writing: ZA and TJ; Manuscript review , editing and approval: ZA and TJ\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from\u0026nbsp;corresponding\u0026nbsp;authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the OR and administrative staff of Addis Hiwot General Hospital\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTian JLL, Tian S, Liu Y, Hu X, Wang Y, Wang Y, Lan H, Mackay LE, Shiferaw BD, Yan N, Wang Y, Luo Y, Li L, Wang W. Global, Regional, National Burden of Gallbladder and Biliary Diseases From 1990 to 2021 and Forecasted Trends by 2040. Liver Int. 2025;45(5):e70103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/liv.70103\u003c/span\u003e\u003cspan address=\"10.1111/liv.70103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 40287816.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang XYW, Jiang G, Li H, Li S, Xie L, Bai X, Cui P, Chen Q, Lou Y, Zou L, Li S, Zhou Z, Zhang C, Sun P, Mao M. Global Epidemiology of Gallstones in the 21st Century: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2024;22(8):1586\u0026ndash;95. Epub 2024 Feb 19. PMID: 38382725.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinha SHD, Stoker DL, Friend PJ, Poloniecki JD, Thompson MM, et al. Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics. Surg Endosc. 2013;27:162\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCholes study group WMRC. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg. 2016;103:1704\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdallah HSSM, Sedky ZH. The difficult laparoscopic cholecystectomy: a narrative review. BMC Surg. 2025;25(1):156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12893-025-02847-3\u003c/span\u003e\u003cspan address=\"10.1186/s12893-025-02847-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 40221716; PMCID: PMC11992859.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAerts RPF. The burden of gallstone disease in Europe. Aliment Pharmacol Ther. 2003;18(Suppl 3):49\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsad UWC, Jones MW, Laparoscopic Cholecystectomy. [Updated 2025 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK448145/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK448145/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeus F, dJJ, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;(4):CD006231. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD006231\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD006231\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 17054285.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucocq JSJ, Patil P. Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy. Surg Endosc. 2022;36:6403\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshfaq AAK, Shah AA, Chapital AB, Harold KL, Johnson DJ. The difficult gall bladder: outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg. 2016;212(6):1261\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBallal MDG, Willmott S, Corless DJ, Deakin M, Slavin JP. Conversion after laparoscopic cholecystectomy in England. Surg Endosc. 2009;23:2338\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-009-0338-1\u003c/span\u003e\u003cspan address=\"10.1007/s00464-009-0338-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang WJLJ, Wu GZ, Luo KL, Dong ZT. Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy. Anz J Surg. 2008;78:973\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1445-2197.2008.04714.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1445-2197.2008.04714.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaki-Eldin A, Badawy AE, OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY IN, PATIENTS WITH GALLSTONE DISEASE AT A SECONDARY LEVEL CARE HOSPITAL. Arq Bras Cir Dig. 2018;31(1):e1347. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/0102-672020180001e1347\u003c/span\u003e\u003cspan address=\"10.1590/0102-672020180001e1347\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 29947681; PMCID: PMC6049991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMBATHA SZA F. Sept. Outcomes in laparoscopic cholecystectomy in a resource constrained environment. S. Afr. j. surg., Cape Town, v. 54, n. 3, pp. 8\u0026ndash;12, 2016. Available from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u0026thinsp;http://www.scielo.org.za/scielo.php?script=sci_arttext\u0026amp;pid=S0038-23612016000300003\u0026amp;lng=en\u0026amp;nrm=iso\u003c/span\u003e\u003cspan address=\"http://\u0026thinsp;http://www.scielo.org.za/scielo.php?script=sci_arttext\u0026amp;pid=S0038-23612016000300003\u0026amp;lng=en\u0026amp;nrm=iso\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u0026gt;. access on 04 Nov. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHana Abebe MB, TRENDS AND OUTCOMES, OF CHOLECYSTECTOMY; A COMPARATIVE STUDY OF OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY, Ethiop Med J. 2021, 59, No. 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong GYMWH, Roth Cardoso V, Bravo Merodio L, Rajeev Y, Maldonado RD, Martinino A, Balasubaramaniam V, Ashraf A, Siddiqui A, Al-Shkirat AG, Mohammed Abu-Elfatth A, Gupta A, Alkaseek A, Ouyahia A, Said A, Pandey A, Kumar A, Maqbool B, Mill\u0026aacute;n CA, Singh C, Pantoja Pachajoa DA, Adamovich DM, Petracchi E, Ashraf F, Clementi M, Mulita F, Marom GA, Abdulaal G, Verras GI, Calini G, Moretto G, Elfeki H, Liang H, Jalaawiy H, Elzayat I, Das JK, Aceves-Ayala JM, Ahmed KT, Degrate L, Aggarwal M, Omar MA, Rais M, Elhadi M, Sakran N, Bhojwani R, Agarwalla R, Kanaan S, Erdene S, Chooklin S, Khuroo S, Dawani S, Asghar ST, Fung TKJ, Omarov T, Grigorean VT, Boras Z, Gkoutos V, Singhal G, Mahawar R. AMBROSE Collaborative. 30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study. Ann Surg. 2025;281(2):312\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SLA.0000000000006236\u003c/span\u003e\u003cspan address=\"10.1097/SLA.0000000000006236\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2024 Feb 13. PMID: 38348652; PMCID: PMC11723498.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePucher PHBL, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R, SAGES Safe Cholecystectomy Task Force. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00464-017-5974-2\u003c/span\u003e\u003cspan address=\"10.1007/s00464-017-5974-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Mar 19. PMID: 29556977; PMCID: PMC5897463.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cholithiasis, cholecystectomy, laparoscopy","lastPublishedDoi":"10.21203/rs.3.rs-8300999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8300999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLaparoscopic cholecystectomy remains the gold standard and minimally invasive surgery for management of gallbladder disease, offering safe outcome. However, significant disparities exist across low -middle income countries. This study presents surgical outcomes of laparoscopic cholecystectomy performed at a high-volume general hospital with a hepatobiliary surgeon in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe institutional based cross-sectional observational study was carried out at Addis Hiwot General Hospital, Addis Ababa. Based on previously published literature, a structured questionnaire was created for this study with the goal of collecting thorough data. Frequencies and percentages were used to summarize categorical variables, and the χ\u0026sup2; test was used to compare groups. The Shapiro-Wilk test was used to evaluate the distribution of continuous variables. Means and standard deviations (SD) were reported for data that was normally distributed; medians and interquartile ranges (IQR) were used for data that was not normally distributed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA retrospective analysis of 424 patients who had laparoscopic cholecystectomy revealed that the female-to-male ratio was roughly 5:1, and the mean age was 42\u0026middot;2 years (SD 12\u0026middot;7). Ninety-one percent of cases involved elective procedures. In 62\u0026middot;0% of patients, symptomatic cholelithiasis (biliary colic) was the most common indication, followed by chronic calculous cholecystitis (22\u0026middot;9%). The conversion rate to open cholecystectomy was 3\u0026middot;5% overall. Within 30 days, 2.8% of patients experienced postoperative complications; no deaths were reported.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite significant inequity in access to Laparoscopic cholecystectomy, the procedure remains safe with low morbidity, conversion rate and no mortality. These findings underscore the urgent need for investment in surgical infrastructure and human resource capacity to expand access to safe laparoscopic surgery in low-resource settings.\u003c/p\u003e","manuscriptTitle":"Outcome of Laparoscopic cholecystectomy among patients operated at a general hospital in a low-income country, Addis Ababa, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 13:43:42","doi":"10.21203/rs.3.rs-8300999/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-09T13:04:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-09T08:08:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T13:15:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62927734219077880400330058820976893113","date":"2025-12-25T12:18:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-24T11:49:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289306647647685825016039822545393508202","date":"2025-12-21T22:42:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155320004946047558556453371465696572321","date":"2025-12-21T17:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174796790910499363382747098168265231374","date":"2025-12-21T11:12:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133333304366220997270601846430737338887","date":"2025-12-19T10:16:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139650452750129978695467841412001543587","date":"2025-12-18T10:57:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112685682920678373224352998276000467838","date":"2025-12-18T00:30:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287879474422931970666644070039053272185","date":"2025-12-17T10:11:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264159782758730296241796095414897730811","date":"2025-12-16T10:44:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T10:33:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-16T09:40:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-12T11:59:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-12T11:58:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-12-07T16:12:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcac2424-5cff-4343-a357-81a6efbbbd45","owner":[],"postedDate":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:05:31+00:00","versionOfRecord":{"articleIdentity":"rs-8300999","link":"https://doi.org/10.1186/s12893-026-03625-5","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2026-02-23 15:58:53","publishedOnDateReadable":"February 23rd, 2026"},"versionCreatedAt":"2025-12-19 13:43:42","video":"","vorDoi":"10.1186/s12893-026-03625-5","vorDoiUrl":"https://doi.org/10.1186/s12893-026-03625-5","workflowStages":[]},"version":"v1","identity":"rs-8300999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8300999","identity":"rs-8300999","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}