Cholecystectomy remains the definitive treatment for symptomatic gallbladder disease. Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) as the standard approach due to its advantages of shorter hospital stay, reduced pain, and faster recovery[1].
However, in resource-limited settings—particularly in developing countries—constraints such as inadequate laparoscopic equipment, unreliable power supply, and shortage of trained personnel often necessitate open procedures.

One of the most common surgical procedures carried out worldwide is laparoscopic cholecystectomy, which also has a high rate of complications. Of the studies included in the evaluation, 38% reported mortality associated with laparoscopic cholecystectomy [2]. To properly plan and prepare for surgery and the recovery time following surgery, it is crucial to identify the elements that influence or predict a difficult procedure.

More people will have access to laparoscopic cholecystectomy procedures as surgical services become more accessible in developing nations. The complexity of doing a laparoscopic cholecystectomy depends on a number of factors, including the patient, the condition, and the operator's expertise. Even the most experienced laparoscopic surgeon may find certain situations challenging, even though trainee surgeons may do various laparoscopic cholecystectomy procedures with ease under the right supervision [3].

Consistent research findings since its inception in the early 1990s have led to the conclusion that laparoscopic cholecystectomy is currently the accepted standard of care for treating gallstone disease. This method is clearly preferable since it reduces the "trauma of access" significantly, which in turn lowers stress cytokines [4]. This decrease is directly linked to a quicker return to normal functioning and an expedited recovery for the patient. Furthermore, the process reduces the size of the surgical wound significantly, which reduces wound-related problems like discomfort, infections, and incisional hernias [5–6]. There is not a study that compares laparoscopic and open cholecystectomies in the Sub-Saharan region. Nonetheless, the documented benefits of laparoscopic procedures, which are widely acknowledged, would be especially beneficial in an area where preventing wound infections and the financial importance of a quick recovery for the labor are highly appreciated [7].

A prospective observational study was conducted in the Department of Surgery at a tertiary care hospital in a resource-limited region between January 2023 and December 2023.

Inclusion Criteria

• All patients aged >18 years undergoing cholecystectomy for symptomatic cholelithiasis, empyema gallbladder, or chronic cholecystitis.

Exclusion Criteria

• Patients unfit for general anesthesia
• Those undergoing cholecystectomy as part of another procedure

Data Collection

Data were collected using a predesigned proforma including demographic profile, indications, type of surgery, intraoperative findings, complications, and outcomes.

Statistical Analysis

Data were analyzed using SPSS v25. Continuous variables were expressed as mean ± SD, and categorical variables as percentages. A p-value < 0.05 was considered significant.

Table 1: Demographic Characteristics of Study Participants

The mean age of patients undergoing cholecystectomy was 45.6 years, with a slight male predominance (52%). The majority of surgeries were performed for symptomatic cholelithiasis (87%).

Table 2: Types of Cholecystectomies Performed

Laparoscopic cholecystectomy was attempted in 75% of the cases, with open cholecystectomy performed in 25% due to technical limitations or patient factors such as adhesions or obesity.

Table 3: Intraoperative and Postoperative Complications

Wound infection was the most common postoperative complication, occurring in 9% of patients. A few cases of bile leak and deep vein thrombosis (DVT) were also reported. The overall mortality rate was 2%, with two patients dying due to sepsis and multiorgan failure following delayed diagnosis and treatment.

Table 4: Length of Hospital Stay and Conversion Rates

The majority of patients (60%) had a hospital stay of fewer than 5 days. Conversion rates from laparoscopic to open surgery were 15%, primarily due to technical difficulties or poor intraoperative visualization.

Cholecystectomy in resource-limited settings presents unique challenges due to limited access to advanced diagnostic tools, surgical expertise, and postoperative care facilities[8]. Despite these constraints, our study found that cholecystectomy, whether laparoscopic or open, is generally safe and feasible in these settings, with a low mortality rate (2%) and manageable complication rates.

Laparoscopic cholecystectomy, though the preferred technique, was successful in only 75% of cases, likely due to the availability of trained laparoscopic surgeons and appropriate instrumentation[9]. Open cholecystectomy was more frequently required in patients with advanced disease or poor anatomical landmarks, such as those with longstanding gallstone disease.

Postoperative complications, especially wound infections, highlight the importance of infection control measures and proper postoperative care. The study also underscores the need for improving infrastructure, such as access to antibiotics, sterile surgical techniques, and adequate postoperative monitoring[10-11].

Case selection was the major reason for the low conversion rate to CL and the minimal complications in our study. Any patient who had acute cholecystitis or a thickened gall bladder would be pre-operatively planned for CL. A review of 29 published articles on the procedure found that the success percentage of the operation dropped from 93% to 59.9% for patients with acute cholecystitis[12-14]. It has also been noted that increased age and higher body body-mass index also contributed to lowering the success rates. In our study, if there were any adhesions or signs of acute inflammation noted on diagnostic laparoscopy, the procedure was immediately converted to CL. As a result, in the period of the learning curve, we were able to perfect the new skills required for SIL on relatively simpler operations. Even without special training in the procedure, by careful case selection, we were able to minimize complications.

Cholecystectomy remains a safe and effective procedure in resource-limited settings, with most patients experiencing good outcomes. However, improving access to laparoscopic techniques, enhancing infection control protocols, and providing better postoperative care could further optimize outcomes and reduce complications. Addressing these challenges is critical to improving surgical care in low-resource environments.

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