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

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 < 0.05) included: age >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.