The Prediction of Difficult Laparoscopic Cholecystectomy for Acute Cholecystitis from Preoperative Clinical Factors and Radiological Findings

<b><i>Purpose:</i></b> This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). <b><i>Methods:</i></b> We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. <b><i>Results:</i></b> Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m² (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; <i>P</i> = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; <i>P</i> = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. <b><i>Conclusions:</i></b> High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.