Critical View of Safety in Acute Gangrenous Cholecystitis

Surgical video: laparoscopic cholecystectomy has a 0.3% to 0.5% morbidity rate due to major biliary injuries. The majority of surgeons have routinely performed the so-called “infundibular” technique for gallbladder hilar dissection since the introduction of laparoscopy in the early nineties. The “critical view of safety” approach has only been recently discussed in controlled studies. It is characterized by a blunt dissection of the upper part of Calot's space, which does not usually contain arterial or biliary anomalies and is therefore ideal for a safe dissection. Gangrenous cholecystitis is a serious complication of acute cholecystitis with increased morbidity and mortality. Authors have shown that acute cholecystitis increases the incidence of bile duct injuries two to threefold. Given this increased risk ofbiliary injury, althogh it is more difficult, making "critical view of safety" may help in decreasing bile ducts /vascular injuries.