Background: Laparoscopic appendicectomy (LA) is widely preferred for acute appendicitis due to reduced postoperative pain, faster recovery, and lower wound infection rates. However, conversion to open appendicectomy (OA) may occur due to intraoperative challenges. Identifying preoperative predictors of conversion could optimize surgical planning and patient outcomes. Objective: This study aimed to identify preoperative factors predicting conversion from LA to OA in patients with acute appendicitis. Methods: A prospective study was conducted at SS Institute of Medical Sciences and Hospital, Davangere, from January 2023 to December 2024. Sixty patients undergoing LA were evaluated. Parameters including age, sex, comorbidities, ASA grading, Tzanaki’s score, leukocyte count, and ultrasound findings were analyzed. Conversion rates and associated factors were assessed using chi-square tests, with significance set at p2 (88.89% conversion, p=0.001), Tzanaki’s score ≤9 (52.38% conversion, p=0.02), and leukocyte count >12,000/mm³ (36% conversion, p=0.02). Sex showed no significant association (p=0.95). Conclusion: Preoperative factors such as advanced age, comorbidities, higher ASA grade, lower Tzanaki’s score, and leukocytosis reliably predict conversion to OA. These findings suggest a preoperative scoring system could guide surgical approach selection, reducing operative time and costs.