Background: Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). The condition of the patient, the level of experience of the surgeon and technical factors all play a role in the decision for conversion. Inability to define the anatomy and difficult dissection are the leading reasons for conversion. Aims and objectives: To compare between and to validate: preoperative ultrasonographic based scoring system and intraoperative scoring system (SURGUE ET AL, IRELAND) as predictors for difficult laparoscopic cholecystectomy. Materials and Methods: This prospective randomized study was conducted at Kempegowda Institute of Medical Sciences Hospital, Bangalore after obtaining the Hospital Ethical Committee clearance for a period of 6 months from AUGUST 2018-JANUARY 2019. Pre-operative Ultrasonographic based scoring system was compared with Intra-operative scoring system to predict laparoscopic cholecystectomy. Results: In the study among those with Easy Pre-operative score, 90.9% had easy, 9.1% had moderate Intra-operative score. Among those with difficult pre-operative score, 33.3% had easy, 11.1% had moderate, 22.2% had difficult and 33.3% had extreme Intra-operative score. There was significant association between Pre-operative score and Intra-operative score. Conclusion: With the help of accurate prediction, high risk patient may be informed beforehand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. Surgeons can also be aware about the possible complications that may arise in high risk patients. Our study also concludes that radiological parameters are good predictors of difficulty.