ABSTRACT Background: One of the most frequently performed surgical procedures worldwide is the laparoscopic cholecystectomy (LC). There is a need to assess numerous factors that may lead to conversion from laparoscopic to open surgery in the case of complicated laparoscopic cholecystectomy. Objective: The aim of the current study was to evaluate the risk factors and predictive models for open surgery (CTO), and surgical quality outcome measures. Patients and methods: This is a prospective observational study was conducted at General Surgery Department, Faculty of Medicine, Zagazig University. A total of 56 patients with symptomatic gall bladder disease were included. Surgical quality outcome were estimated. Results: Male gender was found to be a highly significant factor for predicting of difficult laparoscopic cholecystectomy (DLC) (P=0.026). Also, older age was found to be a significant factor for predicting DLC. Obesity was found to be a significant predictive factor of difficulty in LC. History of previous ERCP was a significant factor for prediction of difficulty as history was positive in 7 (6.7%) patients and 6 (85.7%) patients of them had difficulty during operation. Preoperative ultasonographic findings of thickened gallbladder wall; it was highly significant predictive factor for difficult LC (P=0.005). In this series presence of a thick GB wall may make grasping and manipulation of GB difficult gallstones size; it was a significant predictive factor for difficult LC (P=0.001). The duration of operation was found to be significant factor for predicting difficulty. Conclusion: Pre-operative ultrasound is without a doubt a good predictor of DLC in the majority of instances and should be used as a screening tool, However to predict the challenging LC, greater attention must be given to demographic data, the patient's medical history, and the clinical evaluation.