Laparoscopic cholecystectomy (LC) is considered the treatment of choice for symptomatic cholelithiasis /cholecystitis. However, of all Laparoscopic cholecystectomy attempted, 1-13% requires conversion to open cholecystectomy.

Aims: The present study was conducted to ascertain various patient related pre- operative risk factors for difficult laparoscopic cholecystectomy.

Methodology: A prospective study was carried out at Karnataka Institute of Medical sciences, Hubballi, Karnataka. Forty-five cases diagnosed between 1st October 2013 to 31stJuly 2015 with gall stone diseases following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with risk factors like age, sex, clinical findings, ultrasound imaging and hematological reports.

Results: LC was successfully accomplished in 43 patients (95.5%). Moderate bleeding occurred in 12 patients (26.67%) from the liver bed during gall bladder bed dissection. Gall bladder bed dissection was difficult in 19 patients (42.2%). Gall bladder perforation occurred in 10 patients (22.2%) while stone spillage occurred in 7 patients (15.5%) and were all retrieved. Extraction of the excised gall bladder was difficult in 10 patients (22.2%). Conversion to open cholecystectomy occurred in 2 patients (4%). The preoperative parameters that significantly predicted difficult LC were based on the presence of local signs of cholecystitis in addition to the ultrasound criteria of liver cirrhosis, impacted stone at the neck of the gall bladder and thick walled gall bladder exceeding 4mm.

Conclusions: Clinical and ultrasonographic findings may help predict a difficult LC. This information may be useful to both the patient and the treating surgeon.