Background: Laparoscopic cholecystectomy is a preferred surgical approach for gallbladder diseases. Predicting procedural complexity is vital for minimizing complications, enhancing surgical planning, and guiding surgeon selection. This study aimed to identify preoperative factors predicting difficult laparoscopic cholecystectomy. Methods:This cohort study included 210 patients undergoing laparoscopic cholecystectomy. Patients requiring common bile duct exploration, those with gallbladder malignancy, or deemed unfit for laparoscopic surgery were excluded. A preoperative scoring system incorporating factors such as age, sex, history of cholecystitis, Body mass index, gallbladder wall thickness, and stone size was used. The Intraoperative parameters assessed were operative time, adhesions, spillage, injury, and conversion rates. Results: Significant preoperative predictors of difficult laparoscopic cholecystectomy included a history of acute cholecystitis (p = 0.00006), presence of comorbidities (p = 0.004), higher ASA grade (p = 0.0025), thickened gallbladder walls (p = 0.021), larger stone size (p = 0.022), and elevated total leucocyte counts (p = 0.00009). Conversion to open surgery occurred in 6.7% of cases, primarily due to dense adhesions, impacted stones, and poor visualization of structures. Conclusion:Preoperative factors such as history of acute cholecystitis, comorbidities, ASA grade, gallbladder wall thickness, large stone size, and elevated leucocyte counts were significantly associated with increased intraoperative difficulty and conversion rates. A standardized preoperative scoring system based on these predictors can improve surgical planning, reduce complications, and enhance patient outcomes.