A clinical study to determine predictive factors for difficult laparoscopic cholecystectomy

Abstract Background: Cholelithiasis, affecting 10–15% of the population, is commonly treated with laparoscopic cholecystectomy. However, in 5–10% of cases, conversion to open surgery is required due to complications. This study aimed to identify predictive factors for difficult laparoscopic cholecystectomy and develop a preoperative scoring system. Methods: A prospective study was conducted at Government Medical College Kota from January 2020 to January 2022, involving 50 patients with confirmed cholelithiasis on ultrasound. Preoperative risk factors were evaluated, and each patient was assigned a score based on clinical assessment and sonographic findings (score <5: easy, 6–10: difficult, 11–15: very difficult). Results: The highest incidence of cholelithiasis occurred in the 5th decade of life, predominantly in females. Abdominal pain was the most common symptom. Significant predictors of difficult laparoscopic cholecystectomy included: · BMI >27.5 (P<0.0001) · History of prior hospitalization (P<0.0011) · Palpable gallbladder (P<0.0245) · Impacted stone (P<0.0170) · Pericholecystic collection (P<0.0392) The preoperative scoring system had a positive predictive value of 91.89% for easy cases and 100% for very difficult cases. The conversion rate to open cholecystectomy was 6%. Conclusion: The proposed scoring system effectively predicts difficult laparoscopic cholecystectomy, aiding in preoperative planning and decision-making.