Abstract
Aim:
This study aimed to validate whether predictive factors can predict difficult laparoscopic cholecystectomy(LC).

Method:
This observational prospective study was conducted at GCS Medical College, Hospital & Research Centerover a period of 2 years, from July 2022 to 2024.
The studied predictive factors were
• Age ≥50 years
• Male sex
• Body mass index (BMI) > 27.5 kg/m²
• History of hospitalization for acute cholecystitis
• History of abdominal surgery
• Palpable gallbladder (GB)
• Ultrasound (USG) findings:
• Pericholecystic fluid presence
• Impacted stones
• GB wall thickness > 4 mm
Detailed history, examination, and risk factor assessment were performed on all 100 subjects. Surgery was performedusing CO2 pneumoperitoneum at a pressure of 10 mmHg with two 5- and two 10-mm ports. The timing was recordedfrom the first incision at the port site until the last port closure. All patients received standard postoperative care andfollow-up.

Results:
The duration of surgery was significantly influenced by factors such as gender (p = 0.015), previous abdominalsurgery (p = 0.034), GB wall thickness (p < 0.0001), past history of cholecystitis, and the presence of impacted stoneson USG (p = 0.014). Conversely, factors like age, BMI, pericardial fluid, and clinically palpable GB had no significantimpact, as observed in the study.

Conclusion:
The use of a preoperative scoring system to predict difficult LC is effective, offering advantagessuch as reliance on commonly performed tests, no need for specialized equipment, and ease of understanding andimplementation.

Key words: Gallbladder, Laparoscopic cholecystectomy, Difficult cholecystectomy, Pre-operative assessment of gallbladder operation