Perioperative Outcomes and Complications of Laparoscopic Cholecystectomy in End-Stage Renal Disease Patients: A Prospective Comparative Study.

Abstract

End-stage renal disease (ESRD) patients have increased gallstone disease prevalence and unique perioperative challenges. In ESRD patients awaiting renal transplantation, asymptomatic gallstones identified during pre-transplant evaluation carry additional clinical significance given the disproportionate risk of post-transplant biliary emergencies. Limited literature exists regarding laparoscopic cholecystectomy (LC) outcomes in this population. True prospective observational study, CTRI-registered (CTRI/2016/12/007489) was conducted from December 2016 to March 2020 at a tertiary hospital in Eastern India. ESRD patients (n = 109) on maintenance hemodialysis were matched 1:2 with controls (n = 224) based on age, sex, BMI, and gallstone characteristics. Primary outcomes included ICU admission rate, major complications (Clavien-Dindo ≥ 3), and conversion to open surgery. ESRD patients demonstrated significantly higher complication rates (61.5% vs. 15.2%, p < 0.001), ICU admission requirements (81.7% vs. 8.0%, p < 0.001), and conversion rates (7.3% vs. 1.8%, p = 0.009). Major complications occurred in 18.3% versus 0.9% (p < 0.001). Cardiovascular complications affected 22.0% of ESRD patients versus 1.3% of controls (p < 0.001). Mean operative time was longer (89.3 ± 28.4 vs. 76.2 ± 24.1 min, p < 0.001). Hospital stay was extended (4.2 ± 2.8 vs. 2.3 ± 1.1 days, p < 0.001). Independent risk factors for major complications included hemoglobin < 8 g/dL (OR 3.24), LVEF < 50% (OR 2.89), and ASA Grade IV (OR 4.17). Subgroup analysis showed no significant difference in comorbidity burden between asymptomatic (n = 57) and symptomatic (n = 52) ESRD patients (all p > 0.05). Thirty-day mortality was 0.9% versus 0%. For ESRD patients awaiting transplantation, elective pre-transplant LC is remains feasible with appropriate patient selection, preoperative optimization, and intensive postoperative monitoring, and is justified given the severe consequences of post-transplant biliary emergencies, with LC-related post-transplant complications occurring in only 12.2% of transplanted patients, all Clavien-Dindo Grade I. Clinical Trials Registry of India (CTRI/2016/12/007489).