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Review Paper | Surgery | Volume 15 Issue 7, July 2026 | Pages: 1498 - 1501 | India
Predictors of Difficult Laparoscopic Cholecystectomy: A Comprehensive Review of Clinical, Radiological and Intraoperative Risk Factors
Abstract: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease and acute calculous cholecystitis. Although it is one of the most commonly performed abdominal operations, a subset of patients presents with difficult laparoscopic cholecystectomy also known as (DLC), increasing the risk of prolonged operative time, bile duct injury, conversion to open surgery and postoperative complications. Accurate preoperative prediction of surgical difficulty allows better patient counselling, appropriate case selection, optimal operating room planning and timely involvement of experienced surgeons. Several factors have been identified as predictors of difficult LC. Clinical variables such as advanced age, male sex, obesity, diabetes mellitus, previous upper abdominal surgery and recurrent attacks of acute cholecystitis consistently correlate with increased operative complexity. Laboratory markers including leukocytosis and elevated C-reactive protein reflect severe inflammation and are associated with difficult dissection. Ultrasonographic findings such as gallbladder wall thickness greater than 4 mm, pericholecystic fluid, impacted Hartmann?s pouch stone, contracted gallbladder and obscured anatomy are among the strongest preoperative radiological predictors. Intraoperative grading systems, including the Nassar grading scale, further assist surgeons in assessing operative difficulty and selecting appropriate bailout procedures. Current surgical guidelines emphasize the Critical View of Safety (CVS) as the cornerstone of preventing bile duct injury. When safe dissection cannot be achieved, bailout procedures such as subtotal cholecystectomy or conversion to open surgery are recommended rather than persistence with hazardous dissection. This review summarizes the current evidence regarding predictors of difficult laparoscopic cholecystectomy and highlights practical strategies for improving operative safety and reducing complications.
Keywords: Laparoscopic cholecystectomy, difficult cholecystectomy, gallstones, predictors, Critical View of Safety, subtotal cholecystectomy
How to Cite?: Dr. Kailash Mogal, Dr. Abu Mushtaq Bhat, "Predictors of Difficult Laparoscopic Cholecystectomy: A Comprehensive Review of Clinical, Radiological and Intraoperative Risk Factors", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 1498-1501, https://www.ijsr.net/getabstract.php?paperid=SR26717085657, DOI: https://dx.doi.org/10.21275/SR26717085657