History of Recurrent Acute Cholecystitis Admissions as a Predictor of Operative Time and Bile Spillage: A Retrospective Cohort Study

Abstract

Background: Repeat acute cholecystitis hospitalization could be cumulative inflammatory exposure and scarring in Calot triple, which might complicate surgery. We tested the hypothesis that prior acute cholecystitis admission predicted the duration of the operation and bile spillage during the operation in patients undergoing index laparoscopic cholecystectomy.

Methods: Our study was in the form of a retrospective cohort study conducted at Sardar Vallabhbhai Patel (SVP) Hospital, Ahmedabad, a teaching hospital of NHL Municipal Medical College, Ahmedabad. Included were adult patients who experienced laparoscopic cholecystectomy due to acute calculous cholecystitis between December, 2022, and December, 2025 (N= 200). The exposure variable was the count of recorded preceding hospital admissions of acute cholecystitis in the past, 0, 1, or 2 admissions. Operative time (incision to close time, minutes) and bile spillage (recorded gallbladder perforation with visible bile leak +/- stone leakage) were primary outcomes. Predictors of operative time were estimated using multivariate linear regression, and predictors of bile spillage were estimated using multivariate logistic regression, controlling age, sex, BMI, ASA class, symptom duration, Tokyo severity grade of the Tokyo Guidelines, ultrasound/CT exposure (wall thickness, pericholecystic fluid) and surgeon experience level..

Results: Of 200 patients, 92 (46.0%) had 0 prior admissions, 62 (31.0%) had 1, and 46 (23.0%) had ≥2. Mean operative time rose stepwise with prior admissions (0: 62.1±18.4; 1: 74.3±22.1; ≥2: 92.4±27.6 minutes; p<0.001). Bile spillage occurred in 13/92 (14.1%), 14/62 (22.6%), and 19/46 (41.3%), respectively (p<0.001). After adjustment, each additional prior admission independently predicted longer operative time (β=+9.6 minutes/admission, SE 1.8, p<0.001) and higher odds of bile spillage (adjusted OR 1.75, 95% CI 1.28–2.42, p=0.001). Conversion to open surgery and bailout subtotal cholecystectomy were more frequent in the ≥2 group.

Conclusion: The presence of a history of recurrent admissions of acute cholecystitis was a powerful, independent indicator of increased operative time, and the spillage of bile in laparoscopic cholecystectomy. Admission history is a modest preoperative indicator that can enhance planning of the operation, risk advisory, and assignment of seasoned surgical units.