In a severely inflamed gallbladder, the safest operation is sometimes not a complete cholecystectomy. If the critical view of safety cannot be obtained after a reasonable attempt, the recognised options are subtotal cholecystectomy, cholecystostomy, or conversion, and asking a second surgeon to look.
The decision is easier when it is planned. Agree before starting what your stopping point will be, and say it aloud at the time-out for a hard case.
- Decide your bailout strategy before the first port goes in.
- If the critical view of safety is not reached, do not divide structures.
- Subtotal cholecystectomy is an accepted, safe end-point.
- Ask for a second opinion in theatre before forcing the dissection.
Why it matters
Bile duct injury happens when the plan is to finish at any cost.
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