Introduction:Laparoscopic cholecystectomy is the gold standard for the treatment of cholelithiasis; however the conversion rate varies from 1-20%. In spite of the recent advances both in terms of surgeon’s experience / technique and the availability of newer sophisticated instruments the incidence of conversion is actually true. This conversion is neither a failure nor a complication, but an attempt to avoid complications. Our aim was to evaluate the various preoperative risk factors that could accurately predict the conversion from laparoscopic to open cholecystectomy. Methods: All patients who had undergone cholecystectomy over the 12-month period from July 2007 to June 2008 at our hospital were included in the study. Retrospective analysis of the charts of these patients was done. Clinical, hematological, biochemical, imaging parameters and operative findings were recorded. Patients with additional procedures planned or who had a provisional diagnosis of gall bladder cancer were excluded from the study. Results: Four hundred and seventy one patients successfully underwent cholecystectomy over a 12-month period from July 2007 to June 2008. 1.91% (9/471) patients were directly planned for open cholecystectomy. Overall conversion rate in our study was 4.67% (22/471). The most frequent reason for conversion was severe inflammation and unclear anatomy at calot's triangle (n=12) followed by adhesions (n=6) and gangrenous cholecystitis (n=3). One patient had to be converted to open approach because of severe obesity and failure to create pneumoperitoneum. Multivariate analysis identified elderly patients (>60 years), elevated white cell count (>11,000/cu mm), elevated bilirubin (>1.5mg/dL), CBD stones, evidence of gall bladder wall thickness (>3mm) and/or pericholecystic fluid (either on Ultrasound / CT scan) and a positive HIDA scan as independent predictors of conversion. The post graduate year of resident assisting in the case had no significant effect on conversion rate.Conclusion:Pre-operative clinical and imaging findings can successfully predict in selecting the laparoscopic or open approach or on the least can alert the surgeon for a possible difficult surgery. Apart from choosing the approach, it also improves patient counseling, helps in better perioperative planning and decreases post operative morbidity and hospital costs.