Introduction: Laparoscopic cholecystectomy (LC) has become the gold standard for treating symptomatic cholelithiasis due to its advantages over open surgery. However, certain cases present significant surgical challenges, leading to prolonged operative time, conversion to open surgery, or complications. Identifying predictive factors for difficult LC is crucial for operative planning and patient counseling. Aims and Objectives: To identify and analyze preoperative and intraoperative factors contributing to difficult laparoscopic cholecystectomy and determine significant predictors of surgical complexity in LC cases. Methodology: This prospective observational study was conducted at Sarojini Naidu Medical College, Agra, from October 2022 to August 2024. Ninety patients aged 20-50 years with cholelithiasis or cholecystitis scheduled for elective LC were included. Statistical analysis was performed using SPSS version 27. Results: The study included 90 patients (mean age 38.2±9.23 years; 76.7% female). Significant predictors of difficult LC included age >50 years (p<0.001), history of acute cholecystitis (p=0.002), gallbladder wall thickness >4mm (p=0.010), pericholecystic collection (p<0.001), and stone at neck/cystic duct (p=0.002). Intraoperatively, operative time >100 minutes (p<0.001), conversion to open surgery (3.3%), and bile spillage (3.3%) were significantly associated with surgical difficulty. Conclusion: Multiple preoperative and intraoperative factors significantly predict difficult laparoscopic cholecystectomy. These predictors can enhance surgical planning, reduce complications, and improve patient outcomes.

Laparoscopic cholecystectomy, difficult surgery, predictive factors, cholelithiasis, surgical complications, operative time