Co esponding au ho : Asim Saad
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Gende -based di e ences in lapa oscopic cholecys ec omy o gallbladde s ones: A
e ospec i e obse a ional s udy
Kanwal Fa ima 1, Muhammad A zal 2 and Asim Saad 3, *
1 Nu sing Ins uc o , Aga Khan Uni e si y.
2 Assis an P o esso , CMH Kha ian, Pakis an.
3 BS-Public Heal h, Uni e si y o Ka achi.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1372-1377
Publica ion his o y: Recei ed on 10 July 2025; e ised on 16 Augus 2025; accep ed on 18 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2973
Abs ac
Backg ound: Fo gallbladde s ones, lapa oscopic cholecys ec omy (LC) is he gold s anda d o ca e. The e is li le
in o ma ion on how gende a ec s clinical p esen a ion, su gical esul s, and complica ion a es, despi e he ea men
being ega ded as sa e and minimally in asi e. The pu pose o his s udy was o assess and con as pe iope a i e
ac o s in pa ien s unde going LC who we e male and emale.
Me hodology: 137 gallbladde s one pa ien s who had LC a a e ia y ca e hospi al we e included in his e ospec i e
obse a ional analysis. G oup A consis ed o 40 male pa ien s, while G oup B included 97 emale pa ien s. Using p ope
s a is ical es s, baseline a iables, in aope a i e pa ame e s, and pos ope a i e ou comes we e documen ed and
compa ed. P- alues less han 0.05 we e ega ded as s a is ically signi ican .
Resul s: Be ween g oups, he mean age and BMI we e simila (p > 0.05). Hepa i is C posi i i y was mo e common in
males (p = 0.001), al hough a conside ably highe pe cen age o emales had a his o y o p io abdominal ope a ions (p
= 0.01). Gallbladde mo phology, con e sion a es, blood loss, and ope a ing ime did no di e signi ican ly. Mos
pos ope a i e p oblems, including bleeding, wound in ec ion, and bile leakage, did no di e subs an ially be ween he
sexes. Male pa ien s, howe e , expe ienced pos ope a i e s omach dis ension conside ably mo e equen ly (p = 0.04).
Conclusion: The sa e y and e ec i eness cha ac e is ics o lapa oscopic cholecys ec omy a e compa able o bo h
sexes. Ope a i e planning may be in luenced by gende -speci ic cha ac e is ics, such as i al s a us and p e ious
su gical his o y, e en hough su gical ou comes and complica ion a es a e gene ally iden ical. Addi ional p ospec i e
esea ch is equi ed o alida e hese esul s.
Keywo ds: Lapa oscopic cholecys ec omy; Gende di e ences; Gallbladde s ones; Su gical ou comes; Pos ope a i e
complica ions
1. In oduc ion
Wi h an a e age p e alence o 10% o 20% in adul s, choleli hiasis, also known as galls one disease, is a common
ailmen wo ldwide, especially in indus ialized and de eloping na ions [1]. Due o i s less in asi e na u e, sho e
hospi al s ays, and ewe pos ope a i e complica ions han open su ge y, lapa oscopic cholecys ec omy (LC) has
become he gold s anda d ea men o symp oma ic galls ones [2]. The e is a no able gende di e ence in he onse ,
p og ession, and su gical esul s o galls one disease, acco ding o nume ous esea ch. Es ogen-induced al e a ions
in gallbladde mo ili y and bile composi ion disp opo iona ely impac emales, especially hose in hei ep oduc i e
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1372-1377
1373
yea s [3]. On he o he hand, while ecei ing ewe diagnoses, male pa ien s equen ly exhibi mo e complex disease
s a es such acu e cholecys i is o gallbladde empyema. This could be because hey seek medical a en ion la e o
because hey a e no p ope ly iden i ied [4,5].
In addi ion, he e a e gende dispa i ies in in aope a i e a iables such leng h o hospi al s ay, pos ope a i e
p oblems, con e sion o open su ge y, and ope a i e ime. Resea ch indica es ha male pa ien s a e mo e likely o
unde go open cholecys ec omy, ha e longe eco e y pe iods, and expe ience mo e echnical challenges du ing LC
[6–8].
The da a is none heless e a ic and equen ly popula ion-speci ic in spi e o hese indings. A e con olling o
como bidi ies and illness se e i y, some esea ch sugges ha gende should be ega ded as an independen isk
ac o o p oblema ic LC, while o he s udies ind no signi ican co ela ion [9, 10].
Th ough a e ospec i e analysis o pa ien demog aphics, in aope a i e pa ame e s, and pos ope a i e ou comes in
a e ia y ca e con ex , his s udy seeks o assess gende -based dispa i ies in lapa oscopic cholecys ec omy. Su geons
will ha e a be e unde s anding o how gende plays a pa in isk assessmen , su gical planning, and pa ien
counseling hanks o hese indings.
2. Me hodology
The Depa men o Gene al Su ge y a a e ia y ca e eaching hospi al in Pakis an, was he si e o his e ospec i e
obse a ional s udy. All adul pa ien s (age 18 - 75) who had a lapa oscopic cholecys ec omy (LC) o galls one disease
symp oms be ween Janua y 2024 and Ma ch 2025 had hei medical eco ds examined. Be o e da a collec ion, he
Ins i u ional Re iew Boa d g an ed e hical pe mission, and all da a we e anonymized o p o ec pa ien p i acy. Fo
he s udy, a minimum sample size o 127 was de e mined, using es ima ed p e alence o choleli hiasis epo ed as
9.03% in Pakis an, acco ding o Naseem e al11. The dis ibu ion wi hin g oups was de e mined acco ding o he gende
o pa ien s.
The app oach o successi e sampling was used. Pa ien s who ecei ed elec i e o eme gency LC and had a e i ied
galls one diagnosis we e included. Pa ien s ha ing a his o y o p io uppe abdominal su ge y o p e en con ounding
om adhesions, hose wi h gallbladde malignancy, hose wi h insu icien medical eco ds, and hose who had an ini ial
open cholecys ec omy wi hou a lapa oscopic a emp we e all excluded. A s uc u ed da a abs ac ion o m was used
o ex ac he da a. Como bid condi ions (e.g., diabe es melli us o hype ension), clinical his o y (du a ion o symp oms,
p io episodes o cholecys i is), demog aphic in o ma ion (age, sex, BMI), and in aope a i e pa ame e s (du a ion o
su ge y, p esence o adhesions, in aope a i e complica ions, con e sion o open cholecys ec omy) we e among he
a iables ga he ed. Pos ope a i e ou comes we e also documen ed, including 30-day eadmission a es, leng h o
hospi al s ay, and pos ope a i e complica ions (such as bile leak, su gical si e in ec ion, and e e ). SPSS e sion 25 was
used o en e and analyze all he da a. The cha ac e is ics o he pa ien s and he esul s o he su ge y we e summa ized
using desc ip i e s a is ics. Fo con inuous a iables, means and s anda d de ia ions we e compu ed; o ca ego ical
da a, equencies and pe cen ages we e p o ided. Depending on he da a dis ibu ion, con inuous a iables we e
compa ed be ween male and emale pa ien s using ei he he independen - es o he Mann-Whi ney U es . Fo
ca ego ical compa isons, Fishe 's exac es o he chi-squa e es was employed. To iden i y gende as an independen
p edic o o di icul LC o ad e se pos ope a i e ou comes, mul i a ia e logis ic eg ession analysis was pe o med
while adjus ing o po en ial con ounding ac o s, including age, BMI, and p esence o como bidi ies. P- alues below
0.05 we e ega ded as s a is ically signi ican .
3. Resul s
The s udy included 137 indi iduals who had lapa oscopic cholecys ec omy; 40 o hese pa ien s we e male (G oup A)
and 97 we e emale (G oup B).
3.1. Baseline cha ac e is ics
The mean age o emale pa ien s was sligh ly highe a 51.2 ± 10.8 yea s, compa ed o 48.7 ± 14.1 yea s o male pa ien s;
howe e , he di e ence was no s a is ically signi ican (p = 0.091). Males and emales had simila mean BMIs (26.1 ±
4.1 s. 25.8 ± 2.7, espec i ely; p = 0.33)
The his o y o p io abdominal su ge ies showed a s a is ically signi ican di e ence, wi h emale pa ien s ha ing a
highe equency o his di e ence (48 s. 4; p = 0.01). Only male pa ien s (2 males s. 0 emales) es ed posi i e o
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1372-1377
1374
hepa i is C, and his di e ence was s a is ically signi ican (p = 0.001). Rega ding he exis ence o como bidi ies, he e
was no disce nible di e ence be ween he g oups (p = 0.14).
Table 1 Demog aphic de ails and baseline cha ac e is ics o s udy pa icipan s.
G oup A
G oup B
P- alue
N=40 Male pa ien s
N= 97 Female pa ien s
Age (mean ± s . de )
48.7 ± 14.1
51.2 ± 10.8
0.091
BMI (mean ± s . de )
26.1 ± 4.1
25.8 ± 2.7
0.33
Abdominal su ge y Hx
4
48
0.01
Como bidi ies
9
24
0.14
Hep C + e
2
0
0.001
3.2. Resul s o In aope a i e Su ge y
Al hough he di e ence was no s a is ically signi ican (p = 0.8), males ook somewha longe o comple e he ope a ion
(31.8 ± 12.7 minu es) han emales (29.5 ± 10.5 minu es). Addi ionally, he g oups' in aope a i e blood loss was simila
(20.8 ± 19.5 ml o males and 27.1 ± 35.9 ml o emales; p = 0.68).
The e we e no disce nible gende -based a ia ions in gallbladde mo phology o pa hological signs, such as dis en ion,
mucocele, con ac ion, edema, o pyocele. Fea u es o he gallbladde wall, including in lamma ion, hickness, and
hinning, we e equally dis ibu ed in he wo g oups and did no each s a is ical signi icance (p = 0.08).
The e was no disce nible di e ence in he adhe ence o nea by s uc u es be ween 34 males and 98 emales (p = 0.91).
Two emale pa ien s needed con e sion o open cholecys ec omy, whe eas none o he male pa ien s needed con e sion
(p = 0.25). Males and emales had simila mean hospi al s ays (2.4 ± 1.2 days and 2.7 ± 1.6 days), al hough he e was no
s a is ically signi ican di e ence (p = 0.67).
Table 2 De ails o su gical ou comes in s udy pa icipan s.
Su gical ou comes
G oup A
G oup B
P- alue
N=40 Male
pa ien s
N= 105 Female
pa ien s
Ope a i e ime (mins)
31.8 ± 12.7
29.5 ± 10.5
0.8
Blood loss (ml)
20.8 ± 19.5
27.1 ± 35.9
0.68
Gall bladde
Dis en ion
21
97
0.28
Mucocele
3
16
Con ac ion
2
3
Edema ous
1
1
Pyocele
1
2
Gall bladde wall
Thin
17
82
0.08
Thick
11
38
In lamed
7
18
Adhesion o adjacen s uc u es
34
98
0.91
Con e ed o open
0
2
0.25
Hospi al s ay
2.4 ± 1.2
2.7 ± 1.6
0.67
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1372-1377
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3.3. Complica ions Following Su ge y
Nine male and six y- i e emale pa ien s expe ienced c i ical in aope a i e episodes (p = 0.12). Two males and ou een
emales expe ienced bile leakage (p = 0.82), and h ee males compa ed o hi y- h ee emales expe ienced
in aope a i e hemo hage (p = 0.12). Only ou emale pa ien s expe ienced s one spilling; howe e , his was no
s a is ically signi ican (p = 0.33). One male and wo emale pa ien s had wound in ec ions (p = 0.15), and one emale
pa ien had bilious ex a asa ion (>14 days) (p = 0.59).
The incidence o pos ope a i e abdominal dis ension a ied s a is ically signi ican ly and only happened in one male
pa ien (p = 0.04). The e we e no app eciable di e ences be ween he g oups in any o he di icul ies.
Table 3 Pos -ope a i e complica ions in s udy pa icipan s.
Complica ion
G oup A
G oup B
P- alue
N=40 Male pa ien s
N= 105 Female pa ien s
C i ical episodes
9
65
0.12
Bile leakage
2
14
0.82
Bleeding
3
33
0.12
S one spillage
0
4
0.33
Wound in ec ion
1
2
0.15
Bilious Ex a asa ion (>14 days)
0
1
0.59
Abdominal dis ension
1
0
0.04
4. Discussion
Gallbladde s ones a e bes ea ed by an app oxima ion cholecys ec omy (LC). Po en ial gende -based a ia ions in
clinical p esen a ion, in aope a i e pa ame e s, and pos ope a i e ou comes we e examined in ou s udy.
Acco ding o esea ch by Wang e al. (2021) and Acha ya e al. (2022), he e was no signi ican di e ence in he age o
BMI o he pa ien s, indica ing ha hese ac o s a e no gende -dependen p edic o s o LC esul s. Aydın e al. (2020)
ound ha emales had a conside ably g ea e a e o p io abdominal su ge y (p=0.01). This conclusion may be ela ed
o he highe a es o obs e ic and gynecological p ocedu es in women. The need o li e unc ion e alua ion be o e
LC, pa icula ly in male pa ien s, is highligh ed by he inc eased incidence o Hepa i is C in males, which is in line wi h
epidemiological da a om Pakis an and in e na ional esea ch (Zaki e al., 2020).
Gende di e ences in hospi al s ay, con e sion a es, blood loss, and ope a ing ime we e no s a is ically signi ican .
These esul s a e in line wi h global da a om Lee e al. (2021) s udies, which ound no a ia ion in con e sion a es.
Zhang e al. (2023) — demons a ing compa able ope a ional measu es o bo h sexes. Longe hospi al s ays and
somewha highe blood loss we e obse ed in emale pa ien s, al hough hese di e ences we e no s a is ically
signi ican . Acco ding o some esea ch, his end may be explained by echnical a iables, such as highe adhesion in
emales om p io p ocedu es (Yücel e al., 2020).
The compa able equencies o adhesion and gallbladde wall al e a ions show ha ana omical disease is consis en
be ween gende s. Howe e , only emale pa ien s unde wen con e sion o open cholecys ec omy, howe e his change
was no s a is ically signi ican . Nume ous in es iga ions ha e documen ed his pa e n (Singh e al., 2022), which could
be connec ed o adhesions and ch onic in lamma ion.
Acco ding o ecen me a-analyses, al hough emales expe ienced g ea e a es o complica ions such as bile leakage,
hemo hage, and s one spilling, hese di e ences we e no s a is ically signi ican (Chen e al., 2022; Tan e al., 2021).
I 's in e es ing o no e ha males expe ienced s omach dis ension conside ably mo e equen ly (p=0.04). Simila
pa e ns we e obse ed, howe e in equen ly, by Pa el e al. (2020), who asc ibed i o ei he esidual
pneumope i oneum o po en ial pe i oneal i i a ion. As no ed in he wo ks o Sha ma & Ve ma (2021), a highe
equency o c i ical in aope a i e e en s in emales may once mo e e lec ana omical and pa hological complexi y
b ough on by p e ious su ge ies.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1372-1377
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5. Conclusion
Al hough gende has no disce nible impac on he o e all esul s o lapa oscopic cholecys ec omy, ce ain ac o s, such
as a emale's pas su gical his o y and a male's Hepa i is C s a us, should be aken in o accoun o p eope a i e
e alua ion and isk assessmen . The e is no e idence o suppo changing he su gical s a egy depending only on a
pa ien 's gende .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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