Simultaneous laparoscopic procedures for concomitant abdominal diseases: A comparative observational non-randomized study

Background. Abdominal surgical conditions are among the most prevalent in emergency surgery. The high frequency of concomitant diseases and the need to select the optimal treatment strategy underscore the importance of implementing simultaneous laparoscopic procedures, which can minimize surgical trauma and improve outcomes.

Objective. To evaluate the clinical efficacy and safety of simultaneous laparoscopic procedures in the treatment of concomitant abdominal surgical diseases.

Methods. A comparative, observational, non-randomized clinical study was conducted to evaluate the outcomes of 120 patients with calculous cholecystitis concomitant with other abdominal surgical diseases (physical status class I–III). Through exact matching by age and pathology, two groups were formed to be comparable in key anthropometric data and physical status according to the American Society of Anesthesiologists classification. The main group (n = 60) underwent simultaneous laparoscopic procedures performed according to an original algorithm using a precision dissection technique, while the control group underwent simultaneous open surgeries (n = 60). The study assessed intraoperative parameters, complication rates according to the Clavien–Dindo classification, autonomic regulation dynamics using the Index of Regulatory System Activity, and long-term quality of life (the 36-Item Short Form Health Survey, or SF-36) at 12 months. Statistical analysis was performed employing IBM SPSS Statistics 26.0 (IBM Corp., USA) and Microsoft Excel 2016 software (Microsoft, USA), with the use of Student’s t-test, Mann—Whitney U test, and Pearson’s chi-square test. A p-value of < 0.05 was considered statistically significant.

Results. The combination of laparoscopic procedures resulted in a 39.4% reduction in mean operative time (95.2 ± 12.5 vs. 157.1 ± 16.5 min in the open surgery group; p = 0.011) and a 2.2-fold decrease in blood loss (120 ± 30 vs. 260 ± 40 mL; p = 0.014). The overall complication rate in the main group was 4.1 times lower than in the control group (11.7% vs. 48.3%; p = 0.0001), while the risk of severe postoperative complications (Grade IIIb) decreased fourfold (5.0% vs. 20.0%; p = 0.012). Postoperative mortality was 0% in the laparoscopic group and 5.0% in the control group. By Day 7, the Index of Regulatory System Activity in the main group had normalized (3.4 ± 0.9 points), whereas functional stress persisted in the open surgery group (5.5 ± 0.7 points; p < 0.001). Length of hospital stay was 1.6 times shorter (6.4 vs. 10.2 days; p = 0.009). One year after simultaneous laparoscopic procedures, the SF-36 Physical Component Summary score improved by 41%, significantly exceeding the 24% improvement observed in the control group (p = 0.011).

Conclusion. Simultaneous laparoscopic procedures performed for concomitant abdominal diseases demonstrate high clinical efficacy and safety. This approach reduces the operative time, minimizes blood loss, lowers complication rates, and accelerates patient recovery. These findings support the widespread adoption of this method in abdominal surgery.

1. Doluweera D, Silva O, Seneviratne SL, De Zoysa I. Safety of Simultaneous Laparoscopic Cholecystectomy and Inguinal Hernia Repair: A Systematic Review. J Laparoendosc Adv Surg Tech A. 2025;35(1):22–30. https://doi.org/10.1089/lap.2024.0287

2. Kazi M, Patkar S, Saklani A. Simultaneous laparoscopic liver metastasectomy and intersphincteric resection for neuroendocrine tumor of the rectum by natural orifice specimen extraction surgery. J Minim Invasive Surg. 2023;26(4):215–217. https://doi.org/10.7602/jmis.2023.26.4.215

3. Nandy K, Kazi M, Patkar S, Varty G, De Souza A, Saklani A, Goel M. Minimally Invasive Simultaneous Colorectal and Liver Resection for Synchronous Colorectal Liver Metastasis-Short-Term Outcomes. Indian J Surg Oncol. 2024;15(2):268–275. https://doi.org/10.1007/s13193-024-01901-5

4. Li Y, Wang L, Guo Y, Zhou J, Zhang N, He X, Wang Y, Zhu W, Wang M, Zhu H, Ding Z, Wu Y, Zhang T, Pan Q, Feng Y, Lin Z, Mao A, Zhang Y, Wang Y, Zhang B, Huang Y, Zhao Y, Wang L. Laparoscopic versus open surgery for liver resection: a multicenter cohort study. Sci Rep. 2024;14(1):26410. https://doi.org/10.1038/s41598-024-76260-w

5. Rosen CB, Wirtalla C, Keele LJ, Roberts SE, Kaufman EJ, Holena DN, Halpern SD, Kelz RR. Multimorbidity Confers Greater Risk for Older Patients in Emergency General Surgery Than the Presence of Multiple Comorbidities: A Retrospective Observational Study. Med Care. 2022;60(8):616–622. https://doi.org/10.1097/MLR.0000000000001733

6. Cassinotti E, Baldari L, Boni L, Uranues S, Fingerhut A. Laparoscopic Cholecystectomy in the Cirrhotic: Review of Literature on Indications and Technique. Chirurgia (Bucur). 2020;115(2):208–212. https://doi.org/10.21614/chirurgia.115.2.208

7. Vitiello A, Berardi G, Velotti N, Schiavone V, Musella M. Simultaneous Small/Medium Umbilical Hernia Repair With Laparoscopic Sleeve Gastrectomy (LSG): Results of a Retrospective Case-matched Study. Surg Laparosc Endosc Percutan Tech. 2021;31(5):519–522. https://doi.org/10.1097/SLE.0000000000000913

8. Chao YJ, Lu WH, Liao TK, Su PJ, Wang CJ, Lai CH, Hung JY, Su PF, Shan YS. Feasibility of simultaneous development of laparoscopic and robotic pancreaticoduodenectomy. Sci Rep. 2023;13(1):6190. https://doi.org/10.1038/s41598-023-33269-x

9. Muaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A, Stukel TA, Karanicolas PJ. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021;273(3):467–473. https://doi.org/10.1097/SLA.0000000000003915

10. Nassar A, Tribillon E, Marchese U, Faermark N, Bonnet S, Beaussier M, Gayet B, Fuks D. Feasibility and outcomes of multiple simultaneous laparoscopic liver resections. Surg Endosc. 2022;36(4):2466–2472. https://doi.org/10.1007/s00464-021-08531-w

11. Perfecto A, Gastaca M, Prieto M, Cervera J, Ruiz P, Ventoso A, Palomares I, García JM, Valdivieso A. Totally laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases: a single-center case series. Surg Endosc. 2022;36(2):980–987. https://doi.org/10.1007/s00464-021-08362-9

12. Zvyagintsev VV, Gorpinyuk VP, Fomov GV, Mukhin AS. Simultaneous interventions in laparoscopic surgeries. Endoscopic Surgery. 2020;26(4):5–11 (In Russ.). https://doi.org/10.17116/endoskop2020260415

13. Toktorov SS, Osumbekov BZ, Osumbekov RZ, Abdullaeva ZhD. Analysis of Simultaneous and Isolated Laparoscopic Surgery With Cholelithiasis. Bulletin of Science and Practice. 2022;8(7):330–335 (In Russ.). https://doi.org/10.33619/2414-2948/80/28

14. Zaytsev OV, Ignatov IS, Ogorel’tsev AYu, Bizyayev SV, Evsyukova MA, Li YuB, Yudin MA, Snegur SV, Bragina IYu, Korobova EG. Simultaneous Treatment of Multifocal Gastric and Sigmoid Colon Carcinoma from Laparoscopic Access: A Case Report. I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):253–260. https://doi.org/10.17816/PAVLOVJ82483

15. Todurov IМ, Perekhrestenko OV, Kalashnikov OО, Kosiukhno SV. Laparoscopic sleeve gastrectomy and simultaneous cholecystectomy: a choice of optimal tactics. Zaporozhye Medical Journal. 2022;24(2):176–180. http://dx.doi.org/10.14739/2310-1210.2022.2.243597

16. Khalid A, Khalil K, Mehmood Qadri H, Ahmad CZ, Fatima W, Raza A, Asif MA, Luqman MS, Jawariah, Nizami MFK. Comparison of Postoperative Complications of Open Versus Laparoscopic Cholecystectomy According to the Modified Clavien-Dindo Classification System. Cureus. 2023;15(8):e43642. https://doi.org/10.7759/cureus.43642

17. Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc. 2022;14(1):1–16. https://doi.org/10.4253/wjge.v14.i1.1

18. Hocevar LA, Fitzgerald BM. American Society of Anesthesiologists Staging. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

19. Nanavati AJ, Prabhakar S. Fast-track surgery: Toward comprehensive peri-operative care. Anesth Essays Res. 2014;8(2):127–133. https://doi.org/10.4103/0259-1162.134474

20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

21. Sammito S, Böckelmann I. New reference values of heart rate variability during ordinary daily activity. Heart Rhythm. 2017;14(2):304–307. https://doi.org/10.1016/j.hrthm.2016.12.016

22. Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S383–412. https://doi.org/10.1002/acr.20541

23. Sazhin VP, Fedorov AV, Panin SI, Sazhin IV, Yudin VA, Podyablonskaya IA, Linchenko DV. Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation. Pirogov Russian Journal of Surgery. 2023;9:5–12 (In Russ.). https://doi.org/10.17116/hirurgia20230915

24. Kim WJ, Lim TW, Park PJ, Choi SB, Kim WB. Safety and feasibility of pure laparoscopic extended cholecystectomy: comparison with the open technique in a propensity analysis at a single center. Surg Endosc. 2021;35(11):6166–6172. https://doi.org/10.1007/s00464-020-08112-3

25. Dhanasekara CS, Shrestha K, Grossman H, Garcia LM, Maqbool B, Luppens C, Dumas RP, Taveras Morales LR, Brahmbhatt TS, Haqqani M, Lunevicius R, Nzenwa IC, Griffiths E, Almonib A, Bradley NL, Lerner EP, Mohseni S, Trivedi D, Joseph BA, Anand T, Plevin R, Nahmias JT, Lasso ET, Dissanaike S. A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study. Surgery. 2024;176(3):605–613. https://doi.org/10.1016/j.surg.2024.03.057

26. Aragone L, Rosasco N, Gutierrez J, Croceri R, Medina P, Pirchi D. Complicated Inguinocrural Hernias: Laparoscopic Vs. Open Surgery in the Emergency Setting. J Abdom Wall Surg. 2025;4:14408. https://doi.org/10.3389/jaws.2025.14408

27. García-Álvarez S, Arnáez De la Cruz M, Rey I, Padilla-Iserte P, Matute L, Gurrea M, Domingo S, Caballer M, Lago V. Endo-cost: efficient economic model of adopting robotic versus laparoscopic gynecological surgery for endometrial cancer. J Robot Surg. 2025;19(1):744. https://doi.org/10.1007/s11701-025-02706-6

28. Pogorelić Z, Ødeverp A, Jukić M. The Safety and Feasibility of Single-Stage Versus Staged Laparoscopic Approach for Acute Appendicitis with Inguinal Hernia in Pediatric Patients: A Comparative Study. J Clin Med. 2025;14(12):4243. https://doi.org/10.3390/jcm14124243

29. Orr NT, Davenport DL, Roth JS. Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone. Surg Endosc. 2013;27(1):67–73. https://doi.org/10.1007/s00464-012-2408-z