A gallbladder becomes 'difficult' when severe inflammation, scarring, or fibrosis makes it impossible to safely identify the structures in Calot's triangle, particularly the cystic duct and cystic artery, before cutting. This situation arises most often with repeated episodes of cholecystitis, Mirizzi syndrome, empyema, or a gallbladder that has contracted and scarred onto surrounding structures. When safe identification cannot be achieved, continuing with standard total removal risks bile duct injury, which is a serious and potentially life-altering complication. At that point a bailout strategy, most commonly subtotal cholecystectomy, is the right clinical decision.
Written by Dr. Moksha Gowda, MBBS, MS General Surgery, Consultant General and Laparoscopic Surgeon, NiSH Clinic, 48, 7th B Main Road, near Vinayaka Temple, 4th Block, Jayanagar, Bengaluru 560011. Phone: +91 9731174360.
