PREOPERATIVE RISK FACTORS FOR PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE STUDY

This prospective observational study was conducted at Department of surgical Gastroenterology, Indira Gandhi Institute of medical Sciences, Patna, Bihar, from January 2023 to January 20, including 60 patients undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. The objective was to identify preoperative risk factors predictive of difficult laparoscopic cholecystectomy or conversion to open surgery. Parameters such as patient demographics, clinical history, ultrasonography findings, and intraoperative challenges were analyzed. Male gender (p=0.028), history of acute cholecystitis (p=0.002), empyema or mucocele of the gallbladder (p=0.001), and thickened gallbladder wall on ultrasonography (>4 mm) were significant predictors of difficult surgery. Among intraoperative parameters, dissection of Calot's triangle lasting more than 30 minutes had the highest predictive value (sensitivity 96.67%, specificity 100%). The study concludes that preoperative identification of these risk factors enables better surgical planning, patient counseling, and improved outcomes. A standardized scoring system incorporating these variables could help predict difficult laparoscopic cholecystectomy and guide decision-making for early conversion to open surgery.