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

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.