—Normal anatomical relationships prevail in less than 70% of patients. Alertness to variations and positive identification before division of any structure in this area provide safety from inadvertent injury to blood vessels and the ductal system.
—An edematous, somewhat rigid, and bulky omentum is adherent to the enlarged, tensely distended, acutely inflamed gallbladder. It is readily reflected away to expose the biliary fossae. After decompressing the distended gallbladder by aspiration with a trocar, the peritoneum is incised to expose the cystic and common ducts.
—The peritoneum has been incised parallel to the common duct in the apparent area of its junction with the cystic duct. The cystic duct is dissected sufficiently to pass a silk ligature about it for identification purposes. The dissection is then extended cephalad and laterally toward the gallbladder wall to expose the cystic artery.
—The cystic artery is
GLENN F. Symposium on Diseases of Gallbladder and Common Bile DuctAcute Cholecystitis. AMA Arch Surg. 1957;75(2):300-306. doi:10.1001/archsurg.1957.01280140138027