Abstract Background: Acute cholecystitis with difficult laparoscopic surgery has impact on operating time and training of juniors. The clinical diagnosis of complicated acute cholecystitis (CAC) remains difficult with several pathological or ultra-sonography criteria used to differentiate it from uncomplicated acute cholecystitis (UAC). Aim of Study: Was to evaluate CRP (C-reactive protein) as a parameter that predict operative difficulty of LC (lapar-oscopic cholecystectomy) or conversion to open surgery. Patients and Methods: A prospective randomized clinical trial was carried out on 150 Laparoscopic cholecystectomies performed from January 2019 to February 2022 at General Surgery Department, Al-Azhar University Hospitals (Cairo) Egypt. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP and white blood cell count (WBC). Results: 150 patients were analysed [124 laparoscopic, 22 difficult laparoscopic cholecystectomy (LC) and 4 C (Conversion to open)]. All patients had a recorded CRP. Median CRP was highest for patients who were converted (280.5) compared to those who had difficult LC (67.40) or LC (7.05). High preoperative CRP, WBC and cholangiopan-creatography, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion. Conclusion: C-reactive protein can be efficient predictor of conversion of Laparoscopic cholecystectomy (LC).