Anesthetic Management in Laparoscopic Surgery for Cholecystectomy at Brazzaville University Teaching Hospital, Republic of Congo

Vollständiger Abstract

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Laparoscopic cholecystectomy has been considered the "gold standard" for the surgical treatment of symptomatic gallstone disease because it numerous advantages. However, this surgical technique presents specific anesthetic challenges. The aim of study was to describe the anesthetic management of laparoscopic cholecystectomies at the Brazzaville University Teaching Hospital (BUTH). This was a retrospective, cross-sectional study conducted from January 1, 2023 to April 30, 2025, at BUTH. All patients aged 15 years and older who underwent laparoscopic cholecystectomy were included. The epidemiological, anesthetic, surgical variables and outcomes were analyzed using Excel 2016 software. Fifty-eight patients underwent laparoscopic cholecystectomy. The mean age was 34.1 ± 14.3 years (range: 15 – 72 years). The sex ratio was 0.3. Symptomatic gallstones (96.5%) were the main indication for surgery. Comorbidities were present in 63.8% of cases, including homozygous sickle cell disease in 72.9%. Symptomatic gallstone disease (96.5%) was the primary indication for surgery. Difficult intubation, as predicted by the Mallampati score, was reported in 8.6%. Patients were classified as ASA 2 (67.2%). An Apfel score ≥ 2 was reported in 45 patients (77.6%). Antibiotics were administered to 89.6% of patients and domined by cefuroxime. All patients underwent surgery under general anesthesia with orotracheal intubation. Capnography was monitored in five patients (8.6%). Hypotension (27.58%) and severe bradycardia (8.62%) were the observed anesthetic complications. Four patients (6.9%) required conversion to laparotomy. The mean duration of abdominal insufflation was 79.9 ± 47.0 minutes and the mean duration of anesthesia was 145.5 ± 53.0 minutes. Postoperative complications were present in four patients with sickle cell disease (6.9%): one bone vaso-occlusive crisis, two respiratory infections and one pneumothorax associated with subcutaneous emphysema, requiring admission to the intensive care unit with an unfavorable outcome. Conclusion: Anesthesia for laparoscopic cholecystectomy is feasible at the BUTH for symptomatic gallstones, even in patients with sickle cell disease. Improved intraoperative monitoring could reduce the risk of postoperative complications.