Laparoscopic cholecystectomy in patients with previous upper midline abdominal surgery: comparison of laparoscopic cholecystectomy after gastric surgery and non-gastric surgery using propensity score matching

Background Previous upper midline abdominal surgery is a reported relative contraindication to laparoscopic cholecystectomy. We aimed to investigate the effects of previous upper abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy; we evaluated the effects of the previous upper abdominal surgery type on laparoscopic cholecystectomy with respect to complications and conversion to open surgery. Methods We prospectively evaluated 1,258 patients who underwent laparoscopic cholecystectomy, including those who underwent upper midline abdominal surgery previously, at a single tertiary referral center. The perioperative and postoperative outcomes—open conversion rate, operation time, intraoperative and postoperative complications, and length of hospital stay—were evaluated. Patients were grouped according to the previous surgical method into the gastric ( n = 77), non-gastric ( n = 40), and control ( n = 1141) groups. Patients in the gastric + non-gastric groups ( n = 117) were 1:1 matched with those in the control group ( n = 117) using propensity score matching (PSM). Results Before PSM, age, sex, open conversion rate, gallbladder status, port number, overall morbidity, and postoperative hospital stay duration did not significantly differ between the gastric and non-gastric groups; the body mass index (22.3 ± 3.4 versus 24.1 ± 3.8 kg/m 2 , p = 0.009) and operation time (129.9 ± 63.6 versus 97.9 ± 51.1 min, p = 0.004) significantly differed. After PSM, age, sex, body mass index, and American Society of Anesthesiology score did not significantly differ between gastric + non-gastric ( n = 117) and conventional groups ( n = 117; the operation time (118.9 ± 61.3 versus 75.8 ± 37.1 min, p