Laparoscopic Dissection in a Chronic Fibrotic Gallbladder Achieving the Critical View of Safety

Laparoscopic cholecystectomy in the setting of a chronic fibrotic gallbladder is often technically demanding because normal anatomical planes are distorted or completely obliterated. Dense fibrosis and chronic inflammation make tissue identification difficult and significantly increase resistance during dissection in Calot’s triangle. The gallbladder wall is frequently thickened and contracted, limiting traction and counter-traction and increasing the risk of bile duct injury. Careful, slow dissection with constant reassessment of anatomy is essential in these cases. Despite these challenges, achieving the critical view of safety remains mandatory and should not be compromised. Meticulous clearance of fibrofatty tissue and clear identification of the cystic duct and artery are key steps before any clipping or division. In this case, chronic inflammation resulted in a cystic duct that was markedly thickened and widened, making secure closure with standard laparoscopic clips unreliable. Therefore, a stapling device was used to safely divide and seal the cystic duct. This case highlights how flexibility in technique, combined with patience and strict adherence to safety principles, allows a safe laparoscopic approach even in severely fibrotic gallbladders.