The goal of this observational study is to assess the role of Apfel's score in predicting postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in patients with symptomatic cholelithiasis. The main questions it aims to answer are:

1. Does Apfel's score accurately predict the occurrence of PONV after laparoscopic cholecystectomy?
2. Which components of Apfel's score are most strongly associated with PONV?

Participants will undergo laparoscopic cholecystectomy under general anesthesia. Researchers will calculate each participant's Apfel score preoperatively, and postoperative outcomes, such as nausea and vomiting, will be monitored for 24 to 48 hours. Researchers will compare PONV incidence among patients with varying Apfel scores to determine if higher scores correlate with a higher risk of PONV.

Inclusion Criteria:

• Patients aged 18 to 90 years.
• Patient scheduled for elective laparoscopic cholecystectomy for symptomatic cholelithiasis.
• Patients who provided written informed consent to participate in the study.

Exclusion Criteria:

• Patients receiving prophylactic antiemetic medications prior to surgery.
• Patients on opioid analgesics for reasons other than the surgical procedure.
• Pregnant women.
• Patients whose laparoscopic cholecystectomy was converted to open cholecystectomy during the operation.

The study population consists of adult patients who are undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis. These patients are treated at the Department of General Surgery at National Medical College Teaching Hospital, Birgunj, Nepal.

The investigators may share de-identified Individual Participant Data (IPD) with other researchers upon reasonable request. Access to the data will be granted after approval by the Institutional Review Committee, and a data-sharing agreement will be required to ensure participant confidentiality and compliance with ethical standards.