Laparoscopic cholecystectomy from fundus downward

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Minimally Invasive Procedures

Background:

• Standard laparoscopic cholecystectomy can be challenging when the cystic duct is difficult to visualize.
• Risk of common bile duct injury is a significant concern in laparoscopic cholecystectomy.
• Alternative surgical approaches are needed to improve safety and outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic cholecystectomy from fundus downward (LCFD).
• To assess LCFD's impact on visualization of the cystic duct and common bile duct.
• To determine if LCFD compromises the retrograde approach for gallbladder removal.

Main Methods:

• LCFD involves initial exposure, clipping, and division of the cystic duct and artery.
• Gallbladder dissection proceeds from the fundus downward.
• The cystic duct is double-clipped and divided after gallbladder removal from the liver bed.

Main Results:

• Twenty-eight LCFD procedures were successfully performed.
• No immediate or late complications were reported in the study cohort.
• The LCFD technique demonstrated improved visualization of critical structures.

Conclusions:

• LCFD is a safe and effective alternative for laparoscopic cholecystectomy, particularly in cases with difficult cystic duct exposure.
• This approach minimizes the risk of common bile duct injury.
• LCFD does not impede the retrograde method of gallbladder dissection.