Aim: This study aims to evaluate the utility of pre-operative abdominal ultrasound in predicting the likelihood of conversion from laparoscopic to open cholecystectomy. Identifying pre-operative ultrasound findings that correlate with conversion can help optimize surgical planning and patient outcomes. Materials and Methods: The study was conducted during August 2022 to February 2023 at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. This prospective observational study was conducted on 100 patients undergoing elective laparoscopic cholecystectomy. Pre-operative abdominal ultrasound was performed to assess gallbladder wall thickness, pericholecystic fluid, the size and number of gallstones, and the presence of adhesions or anatomical anomalies. Intraoperative observations, including difficulties in visualizing or accessing the gallbladder and technical complications, were recorded. The conversion rate to open surgery and its correlation with ultrasound findings were analyzed using statistical methods, with a significance threshold of p < 0.05. Results: Pre-operative ultrasound revealed that 32% of patients had a gallbladder wall thickness >4mm, 18% had pericholecystic fluid, and 12% presented with adhesions or anatomical anomalies. Conversion to open surgery was required in 18% of cases, primarily due to difficulty in visualizing the gallbladder and dense adhesions. Statistically significant predictors of conversion included gallbladder wall thickness >4mm (p = 0.002), pericholecystic fluid (p = 0.01), and adhesions (p = 0.001). Patients who required conversion had significantly longer surgeries and hospital stays, and higher post-operative complication rates. Conclusion: Pre-operative abdominal ultrasound is a valuable tool for predicting conversion from laparoscopic to open cholecystectomy. Key ultrasound findings, such as gallbladder wall thickness, pericholecystic fluid, and adhesions, strongly correlate with conversion, aiding in surgical planning and risk management. Routine use of ultrasound can improve patient outcomes by facilitating early identification of high-risk cases.