What question did this study set out to answer?

This study aims to evaluate a scoring system for predicting difficult laparoscopic cholecystectomy (LC) preoperatively.

January 24, 2026

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy Using Scoring System: A Clinical Observational Study

Key Points

This study aims to evaluate a scoring system for predicting difficult laparoscopic cholecystectomy (LC) preoperatively.
Conducted a prospective observational study with 150 patients undergoing elective LC.
Scored clinical, biochemical, and ultrasound factors contributing to difficulty in LC (total of 15 points).
Stratified patients into risk categories based on scores and analyzed results using chi-square tests and ROC curves.
Difficult LC occurred in 22% of cases, with 2% classified as very difficult.
Significant predictors of difficulty included age >60, male sex, history of cholecystitis, BMI >25, and certain ultrasound findings.
The scoring model achieved an AUC of 0.927, with >6 points indicating 75.76% sensitivity and 98.29% specificity.

Abstract

Abstract Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease. About 5–10% require conversion to open surgery due to complex anatomy or intraoperative complications. Accurate preoperative prediction of difficult LC can improve surgical planning and patient counseling. Aim: To evaluate a preoperative scoring system’s ability to predict difficult LC and guide surgical preparedness. Materials and Methods: Prospective observational study of 150 patients (21–80 years) undergoing elective LC. Preoperative clinical, biochemical, and ultrasound factors were scored (total 15 points) and patients stratified into risk categories. Analysis used chi-square/Fisher’s exact tests and ROC curves. Results: Difficult LC occurred in 22% (very difficult 2%). Significant predictors ( P 60, male sex, history of cholecystitis, BMI >25, supra-umbilical scar, elevated ALP, GB wall >4 mm, impacted stone, contracted GB, and CBD >7 mm. The model’s AUC was 0.927; score >6 predicted difficulty with 75.76% sensitivity and 98.29% specificity (LR+ 44.3). Conclusion: The preoperative scoring system reliably predicts difficult LC. High-score patients (>6) may be triaged to experienced surgeons or considered for early open conversion to reduce complications.

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