Background: Laparoscopic cholecystectomy (LC) is considerably performed world over. The entire number of patients suffering serious complications is noticeably high in spite of its low incidence rate, referring it a “rare but frequent" problem. Perioperative prediction of “difficult Laparoscopic cholecystectomy (LC) and operative grading system may not only improve patient safety but also be beneficial in lessening the overall cost of therapy and it may aid a surgeon in the decisive, most convenient approach (open /laparoscopic) for a particular patient, and advocating the patient about it, in that way, reducing the morbidity, complication. Objective: To identify the pre-operative indicators for difficult laparoscopic cholecystectomy, identify the intra- operative indicators for difficult laparoscopic cholecystectomy, and develop predictive scoring system based on these factors. Patients and methods: The present study was conducted over 50 patients aged between 23 to 59 years who underwent a laparoscopic cholecystectomy at Al-hussien Hospital and Bab-Alsharia Hospital of Al-Azhar University during the period of research from January 2020 to August 2020. Detailed clinical history was obtained that included demographic data consisting of age, sex and obesity, history of previous hospitalization for acute cholecystitis, history of endoscopic retrograde cholangiopancreatography (ERCP) and comorbid diseases (diabetes, or elevated liver enzymes etc). Diagnosis of cholelithiasis was confirmed in patients presenting with abdominal symptoms using an abdominal ultrasonography (USG). Results: Two (4%) of cases were found to have been falling in the age group (20-30) years, 20 (40%) of them were falling in the age group (31-40), 22(44%) had an age ranged between (41-50) years, whereas 6 (12%) of patients were in the age group 51-60 years The mean age was 41.82±7.65 years. In this current work age wasn't found to be correlated with difficult operation. Regarding gender and BMI, the majority of included cases, 33 (66%), were females with the mean body mass index was 29.8± 5.129 and gender was not linked to difficult Laparoscopic cholecystectomy (LC) The net outcome of the present work showed that 33 (66%) cases had easy operation. Furthermore, 14 (28%) patients had difficult laparoscopic cholecystectomy and 3 (6%) were found to be very difficult on laparoscopic cholecystectomy. ROC curve analysis showed that a score above 4.5 was found to be associated with difficult cholecystectomy. As the score increases, difficulty level increases with sensitivity (50%) and specificity (93.9%) and AUROC curve 0.749; P= (0.007). Conclusion: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, gall bladder wall thickness, and presence or absence of pericholecystic collection and palpable gall bladder and/or impacted stones.