Predicting Difficult Laparoscopic Cholecystectomy Based on Clinico-Radiological Assessments

Abstract

Background: Difficult laparoscopic cholecystectomy (LC) increases the risk of operative complications and conversion to open surgery, yet preoperative prediction remains challenging in routine clinical practice. Objective: This study aimed to validate a simple clinico-radiological scoring system for preoperative prediction of difficult LC, focusing on demographic, clinical, and sonographic risk factors, and to assess its diagnostic accuracy in elective surgical candidates. Methods: In this cross-sectional validation study, 155 consecutive adult patients scheduled for elective LC at a tertiary care hospital were enrolled. Inclusion criteria were age 16–60 years with symptomatic gallstone disease; patients with gallbladder malignancy, choledocholithiasis, acute cholecystitis, or unfitness for general anesthesia were excluded. Preoperative clinical assessment and abdominal ultrasound were performed, and a composite difficulty score was calculated for each patient. The primary outcome was intraoperative difficulty (graded I–IV), with Grades III–IV considered “difficult.” Sensitivity, specificity, predictive values, and ROC curve analysis were performed using SPSS v26. The study received institutional ethics approval and adhered to the Declaration of Helsinki. Results: Among 155 patients (mean age 45.3 ± 12.8 years; 67.7% female), 38.1% experienced difficult LC. The preoperative score (>6) demonstrated a sensitivity of 89.8%, specificity of 92.7%, PPV of 88.3%, NPV of 93.7%, and AUC of 0.94, confirming high accuracy. Clinically, difficult cases had significantly longer operative time, higher blood loss, and longer hospital stays (all p < 0.01). Conclusion: The validated scoring system enables reliable preoperative identification of patients at high risk for difficult LC, supporting improved surgical planning, patient counseling, and perioperative safety in real-world practice.