Introduction: Gall stone disease is a very common affliction and Laparoscopic cholecystectomy (LC) is the gold standard treatment for it. Because of various factors, Laparoscopic cholecystectomy can be difficult leading to complications which can be dreadful. If we can anticipate difficulties to be encountered beforehand then one can improve preoperative patient counselling, provide for better per operative planning, optimize operating room efficiency and help avoid laparoscopic-associated complications by performing an open operation. Aim: To identify factors which will predict difficult Laparoscopic Cholecystectomy and to review and if possible propose a scoring system based on risk factors which can predict difficulty in laparoscopic cholecystectomy. Materials and Methods: Relevant data of symptomatic patients with USG proven gall stones who fulfilled inclusion criteria was collected on a proforma. By a scoring method, patients were graded as simple or difficult. Operative findings were noted and inference made from certain parameters to help the operating surgeon code the surgery as simple or difficult. Statistical analysis was used to assess if pre-operative assessment corresponded to intraoperative findings. Results: 25% patients had difficult cholecystectomy which was most common in males (43%) and in age group of 21 to 40 years. Conversion to open surgery was most common in males (7%). Patients whose BMI >27.5, had tenderness over right hypochondrium and gall bladder wall thickness > 3 mm had more chances of difficult Laparoscopic cholecystectomy while duration of symptoms (>1 yr.), contracted gall bladder, number of stones or impaction of stones had no relevance to difficult surgery. Intra operative adhesions was the most common cause for conversion to open surgery. Conclusion: BMI > 27.5kg/m2, Tenderness in RHC and GB wall thickness >3mm is risk factor in predicting difficulty in laparoscopic cholecystectomy. Advance age too acts as a risk factor in predicting difficult laparoscopic cholecystectomy. Using a predictive scoring method one can predict if a laparoscopic cholecystectomy will be difficult or not. This would help in counselling of the patient pre-operatively and make adequate arrangement pre-operatively for open surgery.
