Publication:

A clinical study to predict difficult laparoscopic cholecystectomy based on clinicoradiological assessment

Background Laparoscopic cholecystectomy is the gold standard for gallstone disease, but operative difficulty varies due to clinical and radiological factors. Predicting difficult cases preoperatively helps improve surgical planning, reduce complications, and guide timely conversion to open surgery.

Methods This prospective study included 50 patients undergoing laparoscopic cholecystectomy between December 2022 and December 2024. Clinical parameters (age, sex, BMI, comorbidities, prior surgery, history of cholecystitis, ERCP) and radiological findings (gallbladder wall thickness, stone characteristics, gallbladder status, Mirizzi syndrome) were recorded. Intraoperative difficulty was categorized as easy, difficult, or requiring conversion to open surgery, based on predefined criteria.

Results Difficult laparoscopic cholecystectomy occurred in 38% of cases, with a 12% conversion rate. Key predictors of difficulty included acute cholecystitis (50%), obesity (58%), age >50 years, and prior ERCP (54.5% difficulty, 45% conversion). Mirizzi syndrome showed 100% difficulty and 75% conversion. Contracted gallbladder and thickened wall (>4 mm) were associated with higher difficulty. Male patients had higher conversion rates (22.2%) despite fewer difficult cases. Stone size and number were not reliable predictors.

Conclusions A combination of clinical and radiological factors can effectively predict difficult laparoscopic cholecystectomy. Acute inflammation, prior ERCP, Mirizzi syndrome, obesity, and advanced age are strong indicators of operative complexity and conversion risk. Preoperative risk stratification enables better planning, improves patient counselling, and enhances surgical safety.