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

Background 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. Methods 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. Results 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%. Conclusions 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. Trial Registration Clinical Trials Registry of India (CTRI/2016/12/007489)