Factors influencing the difficulty of laparoscopic cholecystectomy: A review

Laparoscopic cholecystectomy (LC) is the preferred treatment for symptomatic cholelithiasis, yet conversion to open surgery occurs in a notable proportion of cases due to factors such as dense adhesions, unclear anatomy, or intraoperative complications. Therefore, it is of interest to identify preoperative predictors of difficult LC to guide surgical planning. Across the included studies, factors consistently associated with conversion included gallbladder wall thickness greater than 4-5 mm, contracted gallbladder, acute cholecystitis, age over 60 years and male gender. Other factors such as diabetes mellitus and white blood cell count were not reliably predictive. Thus, we show the importance of structured preoperative assessment and support the use of predictive scoring systems to estimate surgical difficulty, optimize operative planning and improve patient outcomes.