Difficult Laparoscopic Cholecystectomy Research Articles

Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy.

Near-infrared fluorescent cholangiography (NIRFC) with indocyanine green (ICG) as the developer yields clear visualization of the extrahepatic bile ducts and is effective in identifying key structures. Here, we analyzed and compared the surgical outcomes of fluorescent and conventional laparoscopy in cholecystectomy of various difficulties and then assessed the value of NIRFC. This retrospective study collected clinical data from partial patients who underwent laparoscopic cholecystectomy (LC) at the Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University between 2020 and 2021. The study subjects were classified into ICG-assisted and white-light laparoscopy. Two cohorts with homogeneous baseline status were selected based on 1:1 ratio propensity score matching (PSM). Multivariate logistic regression analysis was performed to predict independent risk factors for LC difficulty. Thereafter, the matched cases were classified into difficult and easy subgroups by combining difficulty score and gallbladder disease type, and then the surgical outcomes of the two groups were compared. This study included a total of 624 patients. The patients were classified into the ICG group (n = 218) and the non-ICG group (n = 218) after a 1:1 ratio PSM. Our data showed significant differences between the groups in operative time (P = 0.020), blood loss (P = 0.016), length of stay (P = 0.036), and adverse reaction (P = 0.023). Stratified analysis demonstrated that ICG did not significantly improve the surgical outcomes in simple cases (n = 208). On the other hand, in difficult cases (n = 228), NIRFC shortened operative time (P = 0.003) and length of stay (P = 0.015), reduced blood loss (P = 0.028) and drain placement rate (P = 0.015), and had fewer adverse reactions (P = 0.023). The data showed that five cases were converted to laparotomy while two cases had minor bile leaks in the non-ICG group. There was no bile duct injury (BDI) in all the cases. Furthermore, high BMI, history of urgent admission and abdominal surgery, palpable gallbladder, thickened wall, and pericholecystic collection were risk factors for surgical difficulty. ICG-assisted NIRFC provides real-time biliary visualization. In complicated conditions such as acute severe inflammation, dense adhesions, and biliary variants, the navigating ability of fluorescence can enhance the operation progress, reduce the possibility of conversion or serious complications, and improve the efficiency and safety of difficult LC.

Delayed Cholecystectomy Management for Mirizzi Syndrome.

Mirizzi syndrome is defined as a common hepatic duct obstruction from a cystic duct stone, which results in a severe inflammatory reaction that distorts biliary anatomy and makes surgical intervention challenging. Most case reports describe an open subtotal cholecystectomy as the most common surgical technique with few reports detailing successful laparoscopic interventions. This case involves an 11-year-old African American female who presented with right upper quadrant abdominal pain and imaging consistent with Mirizzi syndrome. She was taken for a laparoscopic cholecystectomy that was quickly aborted due to extensive inflammation. She subsequently underwent endoscopic decompression of her biliary tree by gastroenterology. She returned to the operating room six weeks later for a successful interval cholecystectomy. This case illustrates a unique report of delayed cholecystectomy for management of Mirizzi syndrome, which highlights a potential management strategy that avoids technically difficult laparoscopic cholecystectomy in the acute inflammatory period.

Validation of Nassar Difficulty Grading Scale in Predicting Difficult Laparoscopic Cholecystectomy

Validation of Nassar Difficulty Grading Scale in Predicting Difficult Laparoscopic Cholecystectomy

Incidence of difficult laparoscopic cholecystectomy at a tertiary care hospital in eastern Nepal

Background: Laparoscopic cholecystectomy (LC) is the gold standard modality for the treatment of gall bladder diseases. Sometimes LC needs to be converted to open due to intraoperative complications. A few factors like age, body weight, comorbidities, ASA score, and surgeons’ experience will warn about the possible complications and need for conversion to open. Prior prediction of the difficulties will warn the surgeon to prepare accordingly. The patient’s family will also be counseled regarding it. Objectives: To identify the possible factors for predicting difficult LC. Methods: This was a descriptive cross-sectional study conducted in the general and laparoscopic surgery department at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Simple random sampling technique was utilised in this retrospective analysis. Data were taken from 2021 May to 2022 May after institutional ethical clearance. Descriptive statistics were assessed done using SPSS v.26. Results: A total of 230 cases were included and analysed in the study. The incidence of difficult LC was 17.8%. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 1.3% of the cases. Intraoperative complications were not seen in 87.8% of the patients. The mean duration of hospital stay in difficult LC cases was five days. Conclusion: Predicting difficult LC will not only warn surgeons to be prepared for the possible difficulties but will also help in counseling patients’ families regarding the intraoperative complications and the possible need for the conversion to open.

Predicting difficulty in laparoscopic cholecystectomy preoperatively using modified Randhawa scoring system

Background: Laparoscopic cholecystectomy is a low-risk, minimally invasive operation and currently the standard for treatment of gallstone and gallbladder disease. Preoperative assessment of difficulty is required to prevent problems, ensure readiness, and ensure an effective course of surgery. Methods: In our work, we attempted to use a modified grading system developed by Randhawa et al. to preoperatively predict a difficult laparoscopic cholecystectomy. Age, gender, illness duration, history of prior GB disease, BMI, abdominal scar location (infra or supraumbilical), palpable gallbladder, and sonographic findings (gall bladder wall thickness, pericholecystic collection, and impacted stone) were assessed in patients who had been diagnosed with GB stones and required LC. Depending on the individual surgeon's assessment, a procedure is rated as easy, difficult, or very difficult. Results: On comparison of the test group difficulty level predicted with the gold standard of difficulty level intra op the test group has a sensitivity of 51.9 % and specificity of 100%. The test has a positive predictive value of 100% and Negative predictive value of 91.5%. The test and the gold standard agree on 154 out of 167 having a diagnostic accuracy of 92.21%. The Kappa value of 0.644 indicates very good agreement with a p value of <0.001. Area under the curve indicates 96.1% of the difficulty is predicted by the Total score and significant with p value of <0.001 Conclusions: The current modified Randhawa and Pujahari scoring method is useful and appropriate for forecasting operative outcome in laparoscopic cholecystectomy.

Difficult laparoscopic cholecystectomy: Current experience and management strategies

Difficult laparoscopic cholecystectomy: Current experience and management strategies

Adhesions Detection and Staging Classification for Preoperative Assessment of Difficult Laparoscopic Cholecystectomies: A Prospective Case-Control Study.

Laparoscopic cholecystectomy (LC) is the treatment of choice for cholelithiasis; however, there are procedural difficulties in determining preoperative detection of a difficult LC. The current methods using clinical and sonographic variables to identify difficult LCs have limitations to identify gallbladder adhesions which form the most common cause. We present a new method of evaluation using acoustic radiation force impulse (ARFI)-based virtual touch imaging (VTI) for the detection and classification of these patients. Fifty consecutive patients of cholelithiasis were evaluated preoperatively using conventional scoring system (CSS) and by new adhesion detection and staging (ADS) system, and patients were classified into three classes (I-III) with class I being easy, II and III being moderate-to-high difficulty LCs. Peroperative classification was done based on the difficulty level during surgery after visualization of gallbladder adhesions. The sensitivity, specificity, and area under the curves (AUCs) of both systems were compared. Out of 50 patients, 72% and 54% of patients were in class I by CSS and ADS classification, while 28% and 46% were in class II and III, respectively, and were labeled as difficult LC cases; differences being two classifications were statistically significant (P = 0.02). Sensitivity, specificity, negative predictive value, and accuracy for ADS were 91%, 100%, 93.1%, and 96.0%, and for CSS, 60.9%, 100%, 75%, and 82% with AUCs of 1.0 and 0.63, respectively. ARFI-based VTI accurately detects gallbladder adhesions and can determine the difficult cases of LCs preoperatively using ADS classification and shows higher accuracy than CSS classification, which results in lower operative time and risk of complications.

Serum cholecystokinin levels can be a predictive factor for difficult cholecystectomy: Decreased cholecystokinin receptor levels.

Laparoscopic cholecystectomy (LC) is being performed frequently in general surgery practice. Estimation of difficult cholecystectomy is very important to take precautions against complications. Cholecystokinin (CCK) is an important enzyme for gall-bladder motility. CCK receptor is the target for CCK. Fibrosis and emptying problems of gallbladder are related with difficult cholecys-tectomies. We aimed to evaluate the association between plasma CCK and difficult cholecystectomy and try to explain the mechanism. Prospective cross-sectional study was conducted on a group of patients with cholelithiasis Patients who underwent elective cholecystectomy were classified into easy, difficult and very difficult preoperatively using LC difficulty scores. Pre-operative gallbladder empting ratios were measured by ultrasonography. Serum C-reactive protein, and postprandial serum CCK and pancreas polypeptide levels were measured before the operation. Operation data including operation times, adhesion scores, and complications were collected. Tissue CCK receptor levels and tissue fibrosis scores were obtained. Easy, difficult, and very difficult LC (DLC) groups were consisted of 34, 28, and 8 patients, respectively. Gallbladder emp-tying was 60% in easy LC group, but 15% in very DLC group. Plasma CCK levels in easy group (37.4 pg/ml) were significantly lower than plasma CCK levels of difficult (58.6 pg/ml), and very difficult groups (66.23 pg/ml). Tissue CCK receptor levels of easy, difficult, and very difficult were 372.4, 178.3, and 144.1 ng/100 mg, respectively. Adhesion scores and fibrosis scores of very difficult group were significantly higher than other groups. Operation times were significantly longer in very difficult group. There were two conversions to open in very DLC group (25%). CCK is a reliable parameter for determining the difficulty of LC. Decreased CCK receptor levels with fibrosis of gallbladder are the probably responsible mechanism.

Clinical, laboratory, and radiological predictors of difficult laparoscopic cholecystectomy: A case control study

Clinical, laboratory, and radiological predictors of difficult laparoscopic cholecystectomy: A case control study

Pre-operative predicton of difficult laparoscopic cholecystectomy

Pre-operative predicton of difficult laparoscopic cholecystectomy

Evaluation of Preoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is established as the gold standard for benign gallbladder disease. This study was done for the evaluation of preoperative scoring system given by Randhawa and Pujahari considering various preoperative parameters to predict difficulty in LC. Preoperative prediction of difficult LC using a scoring system considering various preoperative factors in elective/interval LC to predict difficult gallbladder. A prospective study of 120 patients admitted for LC from January 2020 to June 2021 was analyzed. All the patients were evaluated on the basis of Randhawa and Pujahari scoring system with the following variables: age >50 years, male sex, body mass index 25.1-27.5 and >27.5 kg/m2, previous abdominal surgery, prior hospitalization for gallstone disease, palpable gallbladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each variable had given a score. Based on these findings, the surgical procedure was defined as easy, difficult, and very difficult. One hundred and twenty cases satisfying the inclusion criteria were studied comparing different variables and assigned preoperative scoring. A score >5 was considered significant and compared with intraoperative findings. Out of 53 patients having preoperative scores >5, 40 were difficult gallbladders and 13 were easy to operate. Prediction came true in 93.0% of difficult cases and 83.1% of easy cases. From this study, we can conclude that the preoperative scoring system is statistically reliable to predict difficulty in LC in the majority of the cases (area under receiver operator characteristics = 0.935).

AN OBSERVATIONAL STUDY ON PREDICTION OF DIFFICULTIES DURING LAPROSCOPIC CHOLECYSTECTOMY IN CASES OF CHOLELITHIASIS BY PREOPERATIVE ULTRASONOGRAPHY

BACKGROUND: Laparoscopic cholecystectomy has become the treatment of choice for cholelithiasis. Some reliable factors are needed to predict difficulties during laparoscopic cholecystectomy. So, our aim was to study various preoperative ultrasonographic parameters which may predict difficulties in performing laparoscopic cholecystectomy. METHOD: One twenty five patients of cholelithiasis admitted for elective laparoscopic cholecystectomy were studied. Preoperative ultrasonographic parameters such as gall bladder(GB) wall thickness, transverse diameter of GB, pericholecystic fluid collection, gall stone mobility, number of stones & size of largest stone, common bile duct(CBD) diameter and emphysematous cholecystitis were given a score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated with the difficulties faced during laparoscopic cholecystectomy. RESULT: Out of 125 cases, 42(33.6%) cases were found to be difficult during laparoscopic cholecystectomy and 6 cases (4.8%) required conversion to open cholecystectomy. GB wall thickness (p value= 0.00001), transverse diameter of GB (p value= 0.001), pericholecystic fluid collection (p value= 0.00001), dilated CBD (p value=0.007), size of stone (p value= 0.007) found to be statistically significant in predicting difficulties during laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the chances of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy. CONCLUSION: Pre operative ultrasonography in the form of a formulated score is a good predictor of difficulties during laparoscopic cholecystectomy.

Lateral dorsal infundibular approach: an alternative option for the safe completion of difficult laparoscopic cholecystectomy

BackgroundDifficult laparoscopic cholecystectomy (LC) due to acute cholecystitis (AC) increases the risk of bile duct injuries and postoperative complications. Here, we added the lateral dorsal infundibular approach as an initial surgical maneuver during LC to improve outcomes.MethodsWe describe the detailed technical procedure of the lateral dorsal infundibular approach in patients with AC resulting in difficult LC. This technique was developed after nearly 10 years of experience in laparoscopic surgery, and has been routinely used in the past 5 years. We also retrospectively analyzed the perioperative data for 469 patients with difficult LC.ResultsA total of 469 patients with AC received difficult LC between July 2016 and June 2021, of which 438 (93.4%) performed a lateral dorsal infundibular approach. Sixty-four patients (13.6%) had variations of the hepatic bile duct and cystic duct according to preoperative magnetic resonance cholangiopancreatography, 438 patients (93.4%) received elective surgery, 31 (6.6%) received emergency surgery, and 10 (2.1%) underwent conversion. There was no postoperative bile leaks and no bile duct injuries in the described technique.ConclusionDuring difficult LC, the critical view of safety can be gradually achieved by changing the surgical approach to achieve cholecystectomy.

Effect of intra-peritoneal instillation of bupivacaine in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gall bladder. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. Laparoscopic cholecystectomy has become the gold standard for cholecystectomy in the past decade. Most patients are being discharged on the first or second post-operative day. The aim of the study was to evaluate effect of instillation of intra-peritoneal bupivacaine for pain relief in laparoscopic cholecystectomy. The primary outcome is to evaluate pain scores after this procedure.Methods: It’s an institutional based, observational and randomised control study was conducted in a patients undergoing laparocopic cholecystectomy with gall bladder disease in KPCMCH between 18-70 years of age. The study period was 12 months (from June 2021 to May 2022). 100 patients were included in this study.Results: Our study showed that, less number of patients had right shoulder tip pain (in Numerical rating scale) and requirement of rescue analgesia in case compared to control group.Conclusions: We concluded that instillation of intra-peritoneal bupivacaine reduces pain scores after difficult laparoscopic cholecystectomy.

HPB P46 Does the CholeS pre-operative risk score for laparoscopic cholecystectomy correlate to operative time? A single centre experience

Abstract Background NHS waiting lists for elective surgeries including non-urgent laparoscopic cholecystectomies (LC) have severely escalated during the Covid-19 pandemic, with some patients waiting over 2 years for their operations. LCs are highly variable in terms of operative time, difficulty, and risk making theatre utilisation a challenge to effectively clear waiting lists. Nassar et al.[1] developed and validated a pre-operative risk prediction score for predicting the difficult LC using an objective operative difficulty grading system. We aimed to assess if application of CholeS could be used to predict which LC may have longer operative times, and so aid theatre utilisation planning. Methods Consecutive elective LCs performed between May and October 2021 at our institution's day surgery unit were included and analysed. Each patient was scored retrospectively using the CholeS pre-operative risk score from electronic patient records. Operative time was obtained from theatre electronic record systems. Data was collected on conversion to open surgery, post-operative day of discharge, and intra or post-operative complications. Outliers with operating time recorded as <20 minutes were considered data entry errors and excluded from analysis. A ROC analysis was used, which determined a threshold value of 3. This value was used to divide patients into a low-risk (≤3 points) and high-risk (four and above) group. Two-sample independent t-test was used to compare mean operative time between the high-risk and low-risk CholeS score groups. Levene's test was used to determine if variance was equal between groups. SPSS version 27[2] was used for data analysis and statistical tests and p<0.05 was deemed significant. Results 81 LC were included for analysis. 53 patients were low-risk and 26 patients were high-risk. There was a significantly lower operative time in the low-risk group: low-risk = 57.6 minutes (95% CI 52.4–63.0) vs high-risk = 75.8 minutes (95% CI 58.7–92.9), p=0.046. Nine patients had surgeries lasting >90 minutes; 66% of these were in the high-risk LC group. 95% of patients were discharged on day 0, two patients on day 1, and two on day 2 or later. Three patients had conversion to open cholecystectomy and five patients had post-operative complications. Two out of three patients who required conversion to open cholecystectomies were in high-risk patients with high CholeS scores (7 and 10). In one patient, a cholecystoduodenal fistula was found. Cystic duct avulsion occurred in the other. Three out of five patients with post-operative complications were in the high-risk group, with corresponding higher Clavien-Dindo scores (3b, 2 and 2) when compared to the low-risk group (1 for both patients). Conclusions The CholeS pre-operative scoring system could be used to optimise LC theatre allocation. A score of ≤3 has a shorter operative time than a patient with a score of four or more (mean difference = 18.1 mins, 95% CI 4.4–31.9). Prediction of which LCs will be shorter operations could improve theatre utilisation and allow extra cases booking on the operating list. This, in turn, could help reduce the number of patients on the waiting list. Additionally, CholeS could be used to predict patients with more challenging and prolonged operations as well as those at higher risk of open conversion and complications. This could allow such patients to be managed by allocation to inpatient specialist upper GI specialist lists. [1] Nassar, A.H.M., Hodson, J., Ng, H.J. et al. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc 34, 4549–4561 (2020). [2] IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.

Preoperative scoring system validation and analysis of associated risk factors in predicting difficult laparoscopic cholecystectomy in patients with acute calculous cholecystitis: A prospective observational study.

Today laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the presence of severe inflammation makes it challenging for the surgeons to accurately recognize the Calot's triangle which increases the risk of intraoperative complications. The aim of this study was to explore the validity of a scoring system used to predict difficult LC and to analyse the risk factors associated with difficult cholecystectomy in the setting of acute calculous cholecystitis. An observational study was conducted between December 2018 and December 2020 among 132 patients diagnosed with acute cholecystitis, who underwent laparoscopic cholecystectomy. A scoring system by Randhawa et al. was used preoperatively for all of these patients to predict difficult LC, which was correlated to intraoperative difficulties in actual surgery. Data were analysed using the SPSS version 26.0. Mean age was 43.63 ± 13.37, with almost equal representation from both sexes. History of previous attacks of cholecystitis, impacted stone, thickness of GB wall were statistically significant in calculating preoperative difficulty of laparoscopic cholecystectomy. The scoring system had a sensitivity and specificity of 82.6% and 63.5%, respectively. The conversion rate to open cholecystectomy was 6.9%. Analysing the significant risk factors before operating in the presence of an inflamed gallbladder can reduce the overall mortality and morbidity. An accurate preoperative scoring system will enable the operating surgeon to be well prepared with adequate resources and time. The patient attenders can also be counselled regarding the risk involved beforehand.

Hydro-dissection: An Effective Intra-Operative Technique for Difficult Laparoscopic Cholecystectomies

Hydrodissection, a technique used to treat nerve entrapments, involves injecting an anaesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue. Objectives: To assess the efficacy of this technique in all patients undergoing difficult laparoscopic cholecystectomy in terms of operative time, haemorrhage, and intra-operative complications. Methods: A multicenter observational study was conducted at the department of surgery, PAF Faisal Hospital and Anis Bantva Trust Hospital Karachi. A total of 219 patients were included in this study who underwent laparoscopic cholecystectomy for symptomatic gall stones, with age ranging from 18-70 years, with intra-operative Cuschieri classification >1, using a non-probability sampling method. Results: This study included 219 patients from hospital records categorized as per intra-operative difficulty grading of Cuschieri from grade II-IV. The mean age of patients was 40.46 ±12.50 years, with an average duration of symptoms of 16.95 ± 8.73 days. There were 160 (73.1%) males and 59 (26.9%) females. About two-thirds of patients were admitted through the emergency department. The pre-operative and intraoperative diagnosis of patients was symptomatic cholelithiasis 76 (34.7%), acute on chronic cholecystitis (27.9%), chronic cholecystitis 57 (26.0%), empyema and mucocele gallbladder 11 (5%) each, and Gangrenous gallbladder 3 (1.4%) were recorded. Conclusion: This study showed a clear association of intra-operative complicated anatomy during laparoscopic cholecystectomy to its conversion to open cholecystectomy. Techniques of dissection are of significant importance to minimize injuries to vital structures

The Modification of a Preoperative Scoring System to Predict Difficult Elective Laparoscopic Cholecystectomy.

Background: Laparoscopic cholecystectomy (LC) is one of the most common abdominal operations. The difficult cases are still challenging for surgeons. There had been many studies providing several preoperative models to predict difficult LC or conversion. Randhawa's scoring system was a simple and practical predictive model for clinicians. The modification was reported to be more preferable for delayed LC. This study aimed to confirm the advantage of modified predictive model in larger sample size. Materials and Methods: This retrospective cohort study reviewed medical records of patients who underwent LC since January 2017 to December 2021. The difficulty of operation was categorized into three groups: easy, difficult, and very difficult. Multivariate analysis was performed to define significant factors of very difficult and converted cases. The predictive scores were calculated by using the original Randhawa's model and the modification, then compared with actual outcome. Results: There were 567 cases of delayed LC in this study, with 44 cases (7.8%) converted to open cholecystectomy. Four factors (previous cholecystitis, previous endoscopic retrograde cholangiopancreatography, higher ALP, and gallbladder wall thickening) for very difficult group and five factors (previous cholecystitis, previous cholangitis, higher white blood cell count, gallbladder wall thickening, and contracted gallbladder) for conversion were significant. The modification provided the better correlation and higher area of receiver operating characteristic (ROC) curve comparing with the original model. Conclusion: The modification of Randhawa's model was supposed to be more preferable for predicting the difficulty in elective LC. Thai Clinical Trials Registry No. 20220712006.

Assessment of pre and intra-operative predictors for difficult laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy from the day of its introduction has aimed at improving the results of traditional surgical treatment and is regarded as gold standard treatment in cholecystitis. Objective: To assess various operative predictors for difficult laparoscopic cholecystectomy. Material and methods: The present prospective study was conducted over 100 patients with diagnosis of cholelithiasis confirmed by abdominal ultrasonography (USG). Surgical procedure was categorized postoperatively into easy, difficult and very difficult surgical procedure on the basis of time taken in minutes, bile/stone spillage, injury to duct and conversion to open cholecystectomy. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. Data so obtained was analyzed us-ing SPSS-22 data analysis software. Chi square test was used for statistical analysis with p<005 as significant value. Results: The present study found that obesity, co-morbid diseases, previous history of acute cholecystitis or pancreatitis, delayed surgery after 72 hour of gall bladder inflammation, increased thickness of gallbladder, multiple stones, size of calculi more than 1 cm are significant factors that result in difficult and very difficult surgical procedures. Conversion to open cholecystectomy was seen in 25 (25%) patients.

A Study of Preoperative Predictors of Difficult Laparoscopic Cholecystectomy

Introduction : Laparoscopic cholecystectomy is the most commonly performed surgery for various gallbladder disorders nowadays. Difficulty during laparoscopic cholecystectomy is being faced by many surgeons. If the difficulties are detected preoperatively, management can be planed accordingly by the surgeon. In this study, preoperative clinical and radiological evaluation of patient were studied to predict the difficulties during laparoscopic cholecystectomy. Materials and Methods: All patients who are undergoing laparoscopic cholecystectomy are evaluated by their Name, Age, Sex, BMI, clinically palpable gallbladder, ultrasound findings are correlated with the preoperative score for the prediction of difficulty during laparoscopic cholecystectomy in this study. Results: Upon analyzing of risk factors with pre operative risk score, there was a significant association with BMI, palpable gallbladder, GB wall thickness, impacted gall stones and peri cholecystic collection. Conclusion: This study combined the preoperative clinical and radiological parameters for better prediction of difficult Laparoscopic Cholecystectomy. It provides a base for further studies to validate in this aspect, and it also aids in formulating an efficient scoring system for prediction of difficult Laparoscopic Cholecystectomy and reducing the incidence of complications.