Assessment of Preoperative and Intraoperative Factors for Difficult Laparoscopic Cholecystectomy: An Observational Study

Introduction: Cholelithiasis is one of the commonest biliary tract diseases worldwide. Aim: To evaluate preoperative factors and operative findings associated with difficult laparoscopic cholecystectomy in patients with cholelithiasis and gallbladder polyp disease. Methodology: A study was conducted involving 161 patients who were scheduled to undergo laparoscopic cholecystectomy for gallstone disease and gallbladder polyps at the Department of General Surgery, Maharana Bhupal Government Hospital & RNT Medical College, Udaipur, Rajasthan, from November 2023 to June 2024. Result: In our study of 161 patients, significant factors influencing surgical outcomes included age, history of hospitalisation for acute cholecystitis, gallbladder wall thickness, presence of pericholecystic fluid and adhesions, with a notable correlation between these factors and increased difficulty in laparoscopic cholecystectomy, supported by a scoring system that predicts surgical challenges with high sensitivity and specificity. Conclusion: Our study highlights that while laparoscopic cholecystectomy is generally safe, factors such as history of cholecystitis, palpable gallbladder, gallbladder wall thickness, pericholecystic fluid, intraperitoneal adhesions, and high BMI significantly influence surgical difficulty and conversion rates, thereby enhancing preoperative assessment and decision-making.