Background The gold standard treatment for gallstone disease is Laparoscopic cholecystectomy (LC). However, some cases may be technically challenging or require conversion to open cholecystectomy. Preoperative identification of these difficult cases is crucial for optimal surgical planning and patient counselling. Methods A prospective study was conducted on 59 patients undergoing LC. Various Preoperative ultrasonographic parameters such as the ones including gallbladder wall thickness, gallstone mobility, gallbladder size, and common bile duct diameter, were assessed. The difficulty of LC and the need for conversion to open cholecystectomy were evaluated based on operative time, gallbladder perforation, and dissection time. Results Gallbladder wall thickness > 4 mm (OR=4.2, 95% CI: 1.2-14.7, p=0.024) and impacted gallstone mobility (OR=2.8, 95% CI: 1.1-7.3, p=0.037) were significant predictors of difficult LC. These parameters were also associated with a higher conversion rate to open cholecystectomy (p=0.009 and p=0.046, respectively). Impacted gallstone mobility had the highest predictive accuracy for conversion to open cholecystectomy (AUC=0.734), followed by contracted gallbladder size (AUC=0.702) and gallbladder wall thickness > 4 mm (AUC=0.687). Conclusion Preoperative ultrasonographic assessment of gallbladder wall thickness and gallstone mobility can effectively predict the difficulty of LC and the risk of conversion to open cholecystectomy. These findings can help surgeons optimize surgical planning, patient counselling, and intraoperative strategies, ultimately improving patient outcomes and resource utilization in the management of gallstone disease.

Laparoscopic cholecystectomy, preoperative ultrasonography, gallbladder wall thickness, gallstone mobility, difficult cholecystectomy, conversion to open cholecystectomy.