Bile duct injury in an acute cholecystectomy usually follows misidentification in an inflamed Calot's triangle. If the critical view of safety cannot be achieved after a reasonable dissection, a subtotal cholecystectomy, fundus-first approach, cholecystostomy or conversion is safer than pressing on. Agree the bailout threshold before the operation, call a second surgeon early, and document why the critical view was not achieved.
- Do not clip or divide any structure until the critical view of safety is achieved.
- If it cannot be achieved, consider a subtotal cholecystectomy or fundus-first approach.
- Call a second senior surgeon early in a difficult dissection.
- Record in the operation note whether the critical view was achieved.
Why it matters
Most bile duct injuries come from persisting in a dissection that should have been abandoned.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free