In a severely inflamed gallbladder where the critical view of safety cannot be achieved, a subtotal cholecystectomy — leaving the posterior wall or the infundibulum adherent to the hepatocystic structures — is a deliberate safety manoeuvre, not a failure. Decide early, before repeated dissection in the hazardous zone, and document why. Leave a drain, and warn the patient about the possibility of a bile leak and a later ERCP.
- Set a time or step limit for achieving the critical view before converting strategy.
- Choose subtotal cholecystectomy over dissecting blindly near the common bile duct.
- Document the reason for a subtotal operation in the operation note.
Why it matters
Bile duct injuries happen when completing the operation matters more than protecting the duct.
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