Prediction Of Difficult Laparoscopic Cholecystectomy Research Articles

Prediction of difficult laparoscopic cholecystectomy on the basis of preoperative ultrasonography assessment

Background: Laparoscopic cholecystectomy (LC) is widely used for cholecystolithiasis. Abdominal ultrasonography (USG) is the investigation of choice for diagnosis of gall stone and often done before cholecystectomy. It also helps to predict possible complications during peri-operative period. Till now, there is no established definition of difficult LC. Method: Patients diagnosed as cholecystolithiasis confirmed by USG were studied. Nine parameters of abdominal USG had been assessed. Each parameter was divided into two groups, group A and group B based on finding of USG. Total number of USG finding of each group was calculated. Each surgery was assessed and categorise as easy or difficult and co related with total number of USG finding of each group. Results: For difficult LC-group B USG criteria ≥4 with group A USG criterion ≤5 having sensitivity 84.09%, specificity 80.43% and diagnostic accuracy 82.22%. For easy LC-group A USG criterion ≥6 with group B USG criteria ≤3 having sensitivity 80.43%, specificity 84.09% and diagnostic accuracy 82.22%. For easy LC, the mean post-operative stay was 1.57 days and for difficult LC, the mean post operative stay was 2.52 days. Conclusions: Preoperative USG assessment is a good predictor of difficult LC. Thick-walled gall bladder (GB), presence of pericholecystic fluid collection, impacted stone at neck or proximal to neck of GB and contracted GB are good predictors of difficult LC. Gender is not an independent risk factor for difficult LC.

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.

Preoperative clinico-radiological variables for prediction of difficult laparoscopic cholecystectomy

Preoperative clinico-radiological variables for prediction of difficult laparoscopic cholecystectomy

Prediction of difficult laparoscopic cholecystectomy: An observational study

BackgroundLaparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Thus, we aimed to identify predictors for difficult LC. MethodsA retrospective cross-sectional review of surgical records was done. Patients who underwent laparoscopic cholecystectomy on an elective basis from July 2017 to June 2021 were included in the study. We divided our patients into two groups based on operative findings of difficult LC; difficult LC group and non-difficult LC group. We compared patient's demographics, predictors, and perioperative details and analyzed the data. ResultsA total of 338 patients (82 males) with a median age of 47 years were studied. Total difficult LC was found in 52 patients (15.4%). The overall conversion rate was 8.9%. Logistic multivariable regression analysis revealed that; male gender (odds ratio (OR); 0.171, confidence interval (CI),(0.043–0.675), P; 0.012), past history of acute cholecystitis (OR; 0.038, CI; (0.005–0.309), P; 0.002), gall bladder wall thickness (≥4–5 mm) (OR; 0.074, CI; (0.008–0.666), P; 0.020), fibrotic gallbladder (OR; 166.6, CI; (7.946–3492), P; 0.001), and adhesion at Calot's triangle (OR; 0.021, CI (0.001–0.311), P; 0.005) were independent predictors of difficult LC. ConclusionsGender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4–5 mm), fibrotic gallbladder, and adhesion at Calot's triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

Abstract Background: Laparoscopic cholecystectomy is the most frequent operation nowadays for gallbladder stones. It is associated with faster recovery and shorter hospital stay. On the wide use of laparoscopic cholecystectomy, various com-plications appeared. This made researches work on studies to predict the difficulty of laparoscopic cholecystectomy through different scoring system. This study validates the usage of a scoring system for preoperative prediction of intraoperative difficulties of lapar-oscopic cholecystectomy that may help the patient as well as surgeon in being better prepared for intraoperative challenges. Gallbladder-related disease is one of the common surgical elective and emergency indications. Laparoscopic cholecys-tectomy (LC) is the gold standard nowadays for gallbladder removal. The frequency of complications associated with laparo-scopic cholecystectomy varies from 0.5-6%. Complications of cholecystectomy include iatrogenic perforation of gallblad-der with spilt gallstones that is considered the most common, bile duct injury, bile leaks, bleeding and bowel injury. Con-version rate was about 5% of all laparoscopic cholecystecto-mies. Many risk factors have been found to be associated with difficult laparoscopic cholecytectomy. These result in part from patient selection, surgical inexperience, and the technical constraints that are inherent to the minimally invasive approach. Scoring proposed by Randhawa and Pujahari in 2008 is the most used currently. They found its statistically and clinically good test for predicting outcome in LC. This score had positive predictive value of 88.8% and 92.2% for easy and difficult. One of the unique features in this score is the inclusion of palpable Gallbladder that was not reported earlier. But there was no correlation of score and conversion in this study as all cases of conversion were due to anomalous ducts that could have been predicted by MRCP. It included various clinical and ultrasonographic parameters. Aim of Study: To validate a risk score based on the patient's history, physical examination and abdominal ultrasonography parameters for preoperative prediction of difficult laparoscopic cholecystectomy. Patients and Methods: Our study included 30 patients underwent laparoscopic cholecystectomy in Ain Shams Hos-pital and Alamria Hospital. Results: In our study, males were more predominant than females (73.3% vs 26.7%) with mean age of (40.23±13.64) years. Our patients had mean BMI of (28.43±4.03) kg/m2 with most of them were obese (63.3%). Intra operative diffi-culty showed significant relation with sex and BMI. 13.3% of patients had leukocytosis and all our patients had normal alkaline phosphatase. 56.7% of the study patients were presented with previous acute attacks, 20% presented with fever, 6.7% had palpable GB and 33.3% had abdominal scar. Intra operative difficulty showed significant relation with previous acute attack, abdominal scar and GB wall thickness. We found that preoperative scoring had a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 84.6%, diagnostic accuracy of 93.3%, and Kappa agreement of 0.862 compared to the intraoperative scoring system. Conclusion: We strongly recommend using the preoper-ative scoring system for predicting the degree of difficulty for laparoscopic cholecystectomy.

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Aim: To evaluate the factors for prediction of difficult laparoscopic cholecystectomy preoperatively. Methods: A Prospective Observational Study conducted at Surgical Unit II, Ghulam Muhammad Mahar Medical College Hospital Sukkur, from February 2020 to January 2021. Data was collected for 580 patients. All the patients fulfilling inclusion criteria were evaluated with following factors: age, gender, BMI, h/o previous GB disease, comorbids, h/o previous abdominal surgery, tender RHC, palpable gallbladder, ultrasonographic findings of gall bladder wall thickness, pericholecystic fluid collection & stone impaction at neck of gall bladder. Patients were assumed to be difficult on presence of one or more of above mentioned risk factors .laparoscopic cholecystectomy was performed by an experienced laparocopic surgeon. Peroperative findings and operative time was noted. Cases were considered difficult if operative time was >60 minutes or if the case was converted to open. All the information was recorded on predesigned proforma. Results: Age ranged from 23 to 70 years (mean age = 46.37 years). 456 patients were female while 124 patients were male. Majority of patients in our study (n=390) had normal BMI(BMI=18.5-24.9)and next majority (n=132) belonged to overweight group(BMI=25-29.9) . On inquiry, 93 patients had history of previous gall bladder disease in form of cholecystitis. Out of 580 patients, 161 patients had one or more comorbids. 39 out of 580 patients had history of previous abdominal surgery. 78 patients had tender right hypochonrium. 62 patients had palpable gall bladder. On ultrasound 73 patients had gall bladder wall thickness >4mm. In 39 patients pericholecystic fluid collection was found. In 33 patients, stone was impacted at the neck of gall bladder. 161 patients were preoperatively labeled as difficult. All the patients underwent laparoscopic cholecystectomy. Mean operative time was 42.56 minutes. 512 patients underwent uneventful laparoscopic cholecystectomy, in 68 patients difficulty was encountered 11 patients were converted to open procedure. Conclusion: We conclude that a careful insight in certain factors can predict the difficult laparoscopic cholecystectomy preoperatively. It acts as an important eye opener for surgeons to get an idea of the potential difficulty to be faced in that particular patient. Keywords: Laparoscopic cholecystectomy, Preoperative, Gall stones, Difficulty

ACCURACY OF RANDHAWA AND PUJAHARI PREOPERATIVE SCORING SYSTEM IN PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY IN EGYPTIAN POPULATION

Background: Laparoscopic cholecystectomy is the procedure of choice for management of symptomatic gallstone disease and one of the most commonly performed operations by general surgeons. Sometimes, it is difficult and takes longer time or has to be converted to an open procedure due to various difficulties faced while performing the procedure.Aim of the Work: To evaluate the accuracy of Randhawa and Pujahari preoperative scoring system in prediction of difficult laparoscopic cholecystectomy in Egyptian population.Patients and Methods: This is a prospective observational study that has been conducted in department of general surgery, Ain Shams University hospitals, including (60) patients undergoing elective laparoscopic cholecystectomy for symptomatic gall stones disease. The scoring system used was of Randhawa and Pujahari, based on history, clinical examination and radiological finding.Results: Showed that the scoring system is reliable to be used in Egyptian patient with sensitivity 77.78 % and specificity 95.12 %.Conclusion: Ranhawa and Pujahari scoring system are reliable and could be used in Egyptian patients undergoing elective laparoscopic cholecystectomy. This scoring system can help each of patients, surgeons and trainers. With the help of accurate prediction, high risk patient may be informed before operation and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately.

Preoperative prediction of difficult laparoscopic cholecystectomy based on diffusion-weighted magnetic resonance imaging.

Laparoscopic cholecystectomy is a common surgery with a varying difficulty level. Difficult laparoscopic cholecystectomy may be experienced by many surgeons. If difficult procedures are predicted preoperatively, surgeons may be able to plan the surgical approach and treatment accordingly. Studies have reported using blood and clinical imaging data to predict difficult cholecystectomy. However, to our knowledge, no studies have reported using MRI. The purpose of this study was to evaluate the usefulness of MRI as a predictor of difficult laparoscopic cholecystectomy. We retrospectively evaluated 25 patients with cholecystitis or biliary colic who had undergone diffusion-weighted whole-body imaging before laparoscopic cholecystectomy. The apparent diffusion coefficient value of the cystic duct was measured and its relationship with operative time and blood loss was examined to assess the capacity of diffuse-weighted whole-body imaging to predict difficult cholecystectomy. Further, we collected blood data and compared its usefulness as a predictor. The apparent diffusion coefficient value of the cystic duct was significantly lower in patients with difficult laparoscopic cholecystectomy than in those with non-difficult procedures (P= .00007). White blood cell count and serum C-reactive protein level were significantly higher in patients with difficult cholecystectomy than in those with non-difficult procedures (P= .035, .030). In the receiver operating characteristic analysis, the apparent diffusion coefficient value was the best predictor. Our results suggest that the apparent diffusion coefficient value of the cystic duct is a predictor of difficult laparoscopic cholecystectomy. In the future, it may be useful to study changes in coefficient values over time to determine optimal surgical timing.

Preoperative Clinical and Radiological Variables for Prediction of Difficult Laparoscopic Cholecystectomy

Preoperative Clinical and Radiological Variables for Prediction of Difficult Laparoscopic Cholecystectomy

A prospective cohort study for prediction of difficult laparoscopic cholecystectomy

IntroductionDifficult laparoscopic cholecystectomy (DLC) is a stressful condition for surgeon which is followed by greater risk for various injuries (biliary, vascular etc.) Preoperative factors that are related to DLC are landmarks for surgeon to assess the possibilities for overcoming difficulties and making early decision about conversion to an open surgery. In prospective cohort study we evaluated and defined the importance and impact of preoperative parameters on difficulties encountered during surgery, defined DLC, predictors of DLC and index of DLC. Materials and methodsAll patients in the study were operated by the same surgeon. We defined the total duration of the operation as the time from insertion of Veress needle to the extraction of gallbladder (GB) and DLC as a laparoscopic cholecystectomy (LC) that lasted longer than the average duration of LC and the value of one standard deviation. ResultsMultivariate logistic regression analysis identified five predictors significantly related to DLC: GB wall thickness > 4 mm, GB fibrosis, leukocytosis ˃10 × 109 g/L, ˃ 5 pain attacks that lasted longer than 4 h and diabetes mellitus. The sensitivity of the generated index of DLC in our series is 81.8% and specificity 97.2%. ConclusionPreoperative prediction of DLC is important for the surgeon, for his operating strategy, better organization of work in operating room, reduction of treatment expenses, as well as for the patient, for his timely information, giving a consent for an operation and a better psychological preparation for possible open cholecystectomy (OC).

English

English

Evaluation the efficacy of scoring method for pre-operative prediction of difficult laparoscopic cholecystectomy

Laparoscopic Cholecystectomy the procedure of choice for symptomatic Cholelithiasis. Preoperative prediction of a difficult cholecystectomy and the risk of conversion is of great help both to the patient who can plan his work and the surgeon who can also schedule his time and team accordingly. Randhawa developed a scoring method on the basis of History, Clinical Examination and Sonological findings to predict difficult Laparoscopic Cholecystectomy preoperatively. We are conducting this study to evaluate the efficacy of Randhawa scoring method in pre-operative prediction of difficult laparoscopic cholecystectomy and to identify the predictors of difficult laparoscopic cholecystectomy which will help the surgeon to provide better surgical care to the patient.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy Using a Scoring System

Difficulties Throughout laparoscopic cholecystectomies are not extraordinary as a rule surgery, Throughout laparoscopic cholecystectomy [LC]. This ponder pointed on assess part of preoperative demographic What's more sonographic tolerant information will foresee specialized foul challenges Throughout LC. This current contemplate might have been conveyed ahead 100 patients anguish from symptomatic cholelithiasis by and large surgery Branch during Benha college doctor's facilities. Every one patients in this contemplate were subjected of the following, history taking, clinical examination, schedule research center investigations Furthermore abdominal ultrasonography. We evaluated the system viewing preoperative predictive Components of troublesome LC [preoperative scoring system]. Intraoperative Conclusion as viewing those Emulating agent parameters: occasion when made for surgery, bile/stone spillage, harm should cystic conduit or cystic artery, transformation should open cholecystectomy. We resorted of the traditional four port procedure [two 10 mm and two 5 mm ports] utilizing those north american plan. For preoperative evaluation, as stated by Randhawa What's more Pujahari scoring framework we predicted preoperatively that 67% might pasquinade easily, 28% will a chance to be difficult, Furthermore 5% from claiming patients Around this consider predicted on experience exceptionally troublesome LC Also might transformation to open cholecystectomy. Intraoperative outcome, 67 patients who were predicted should a chance to be simple looking into surgery, for which 56 were really easy, inasmuch as nine from claiming them turned out with a chance to be troublesome once surgery, What's more 2 patients were exceptionally troublesome LC. However, the 28% from claiming situations predicted to a chance to be difficult, 20 patients were really difficult, 2 turned out with be exceptionally difficult, Furthermore 6 underwent simple surgery. There were 5 [5%] situations predicted will be exceptionally troublesome looking into surgery, Anyhow you quit offering on that one [1%] pasquinade easily, in turn instance [1%] might have been troublesome What's more 3 [3%] really were exceptionally troublesome. Done our study, An solid measurable relationship might have been discovered the middle of preoperative assessment prediction Furthermore was troublesome LC. The preoperative scoring may be statistically Furthermore clinically a great test for foreseeing the agent result over LC.

Assessment of preoperative patient factors in early prediction of difficult laparoscopic cholecystectomy: A single institution study

Background: Laparoscopic cholecystectomy is the most common elective surgery performed by general surgeon. In certain situations lap cholecystectomy which is supposed to be simple and safe procedure becomes very difficult and unsafe. Therefore early prediction of difficulty level before elective surgeryis an important aspect so that patient can be counseled about the risks and outcomes.Methods: 80 cases of lap cholecystectomy operated by a single surgeon is included in the study. there are total 15 score from history, clinical, and sonological finding, they were evaluated and scored on the basis of scoring system of randhawa and Pujahari. Score up to 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult.Result: the present study found that age, BMI, previous H/O hospitalization, palpable GB clinically, USG finding of increased GB wall thickness, impacted stone are significant factors that result in difficult and very difficult lap cholecystectomy. Conversion to open procedure was seen in 7.5% cases.Conclusion: the scoring system had a positive predictive falue of 83% with sensitivity of 94%.

Analyzing the Factors for Pre-operative Prediction of Problematic Laparoscopic Cholecystectomy: A Cross-sectional Exploratory Study

Background: Laparoscopic cholecystectomy is considered as the preferred treatment for symptomatic Cholelithiasis. Though laparoscopic cholecystectomies are considered a common surgical intervention, still 1-13% requires conversion to open cholecystectomy for various reasons. Pre-operative evaluation of such factors would be helpful to establish criteria that would assess the risk of conversion, hence the rationale for this study. Materials and Methods: A cross-sectional study conducted among patients (n=100) reporting with gall bladder disease and requiring cholecystectomy (aged 10-60 years) not having peritonitis, malignancy, pregnancy and/ or a compromised immune system were recruited in the study. Factors of difficult laparoscopic were assessed by Socio-demographic factors, Inspection and Palpation and USG findings (wall thickness, pericholecystic collection, impacted stone and post ERCP status). Following this, the patient was subjected to laparoscopic cholecystectomy and conversion was noted. SPSSv15.0 was utilized for statistical analysis (*p<0.05). Results: Study subjects with GB wall thickness >3mm, presence of pericholecystic fluid, appearance of WES sign, and subjects having multiple gall stones and/ or CBD stone had a significantly higher level of difficulty in gall bladder extraction, as well as higher chances of complicated bleeding. Overall, 13% subjects required a conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy. Conclusion: Pre-operative prediction of difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for the intra operative risk and risk of conversion to open cholecystectomy.

Pre-operative prediction of difficult laparoscopic cholecystectomy from clinical, hematological and radiological parameters

Background: The aim of study was to formulate a scoring system to predict difficult laparoscopic cholecystectomy (LC) pre-operatively; depending on the specific parameters of an individual patient.Methods: We have included 100 patients who underwent LC from July 2010 to December 2012. Conversion to open cholecystectomy in relation with age, sex, attack of acute cholecystitis, fever, abdominal tenderness, serum amylase and LDH level, status of GB and GB wall thickness, number of stone, leukocyte count and CBD diameter were assessed.Results: The most important reason for conversion was adhesions at Calot's triangle (60%), followed by contracted gall bladder (15%). The other reasons of conversion were empyema of the gall bladder (15%), stone at Hartmann's pouch (10%), bleeding during dissection (5%).Conclusions: This study will surely help the surgical fraternity in the future to plan the particular patients for appropriate mode of surgery, pre-operative preparation, patient counselling and most importantly to predict the score for the difficult interval Laparoscopic Cholecystectomy.

Pre-operative Prediction of Difficulties in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system. Objective: The objective of this study is to evaluate a Scoring system to predict difficult laparoscopic Cholecystectomy. Patients and Methods: Laparoscopic cholecystectomy was done in the department of surgery, EL Hussin University Hospital. The parameters considered in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, and palpable gall bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 50 patients were included in the study. Results: We found that history of hospitalization; palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Conversion rate from laparoscopic to open cholecystectomy was found to be 4%. Conclusion: High risk patient may be informed beforehand regarding the probability of conversion and hence they may have a chance to make arrangements. Surgeons can also be aware about the possible complications that may arise in high risk patients.

Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.

Prediction of Difficult Laparoscopic Cholecystectomy during the First Conversation with the Patient

Prediction of Difficult Laparoscopic Cholecystectomy during the First Conversation with the Patient

Prediction of difficult laparoscopic cholecystectomy while working up the patient for surgery

Introduction: Laparoscopic cholecystectomy [LC] has established itself as standard of care for gallstone disease. With the wide availability of expertise, complication rate and conversion rate both are coming down. Coupled with increase in patient awareness and easy accessibility of information, it is becoming increasingly difficult for surgical team to explain complication arising following surgery. A preoperative prediction can help ease doctor-patient relationship. Objective: To find out the predictors of difficult laparoscopic cholecystectomy while investigating the patient for surgery. Patient and methods: We selected 125 patients based on convenient sampling who underwent LC. A Likert type questionnaire was used to assess the difficulty. Weighted difficulty score [WDS] was calculated as the sum of product of parameter response and difficulty response score [WDS= ∑ (PR x DRS)]. Mean WDS was then compared against preoperative investigation findings. Results: Mean WDS was found to increase with raised leukocyte count as well as with altered liver function tests. Thickened gallbladder wall in ultrasonography had a positive correlation with difficulty in surgery but no association was found with the pericholecystic fluid. A larger size of stone, stone impacted at neck and a larger size of the impacted stone were all had a significant positive association with difficult LC but number of stones in GB had no impact on difficulty during surgery in our study. Altered liver echotexture and a contracted GB were the other factors which can predict a possible difficulty during LC. Conclusion: A careful watch on investigation which include leukocyte count, liver function tests and preoperative ultrasonography can help predict the difficulty, a possibility of conversion as well as complications. A discussion of these events with the patients and their relatives can create an atmosphere of mutual trust and better prepare to overcome of untoward events.