Essential strategies for the management of challenging laparoscopic cholecystectomy procedures

Table 1 Preoperative risk factors for difficult laparoscopic cholecystectomy

n	Factor
1	Obesity
2	Cirrhosis
3	Fatty liver infiltration
4	Elevated American Society of Anesthesiologists score
5	Diabetes mellitus
6	Previous upper abdominal surgery
7	In acute cholecystitis, diabetes mellitus, positive Murphy’s sign
8	Previous acute cholecystitis or percutaneous gallbladder drainage
9	Concomitant common bile duct stones
10	Thickened gallbladder wall in imaging
11	Pericholecystic fluid collection in imaging
12	Impacted gallstone in gallbladder neck in imaging
13	Previous episode of acute biliary pancreatitis
14	C- reactive protein levels > 11 mg/dL in elective procedures