DOI: http://dx.doi.org/10.18203/2349-2902.isj20191879

Advantage of fundus first method over conventional approach in difficult laparoscopic cholecystectomy: a prospective study

Braja Mohan Mishra, Rabi Narayana Guru, Sunil Kumar Kar

Abstract


Background: Fundus first method is a widely accepted and practiced procedure in open cholecystectomy to deal the difficult cases but laparoscopic surgeons still have reserved opinion regarding use of fundus first approach in difficult laparoscopic cholecystectomy (DLC). As in open cholecystectomy fundus first laparoscopic cholecystectomy (FFC) can have advantages over conventional laparoscopic cholecystectomy (CLC) in DLC. So many preoperative, intraoperative, postoperative information were collected in both CLC and FFC and compared to evaluate whether FFC has any advantage over CLC in difficult laparoscopic cholecystectomy.

Methods: A total 73 cases were included in the study that underwent laparoscopic cholecystectomy (LC) for gall stone diseases and intraoperatively found to be difficult cases. They were distributed into 4 classes i.e. Class I, Class II, Class III and Class IV according to the type of difficulty encountered during surgery.

Results: Out of the 73 patients 24 were male and 49 were Female. Age of patient ranged from 14 to 70 years with mean age of 42.64 years. Out of 38 cases operated with FFC 6 cases (15.78%) needed conversion to open cholecystectomy as compared to 26 out of 35 (71.14%) cases that underwent CLC where conversion was done. Mean duration of hospital stay is 4.19±3.053. Mean hospital stay in FFC is 2.58±1.869 days and that of CLC is 5.14±3.143 which is clearly much higher and statistically significant (p< 0.001) than mean hospital stay in case of FFC.

Conclusions: FFC has advantages over CLC in difficult LC i.e. reduced conversion rate, lesser hospital stay and less duration of antibiotic use.


Keywords


Conversion, Difficult laparoscopic cholecystectomy, Fundus first method

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References


Walker R. The First Laparoscopic Cholecystectomy. J Soc Laparoendoscopic Surg. 2001;5(1):89-94.

Yeo, Charles J. Shackelford's surgery of the alimentary tract. Eighth ed. Philadelphia, PA: 2018. ISBN 0323402321. OCLC 1003489504.

Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. International J Surg. 2015;18:196-204.

Orhan Bat. The analysis of 146 patients with difficult laparoscopic cholecystectomy. Int J Clin Exp Med. 2015;8(9):16127-31.

Kama, NA, Kologlu M, Reis E, Atli M, Dolapci M. Risks score for conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001;181:520-5.

Kum CK, Goh PMY, Isaac JR, Tekant Y, NgoiSS. Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1994; 81(11):1651-4.

Nachnani J, Supe A. Preoperative perdiction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol. 2005;24(1):16-8.

Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188:205-11.

Gabriel R, Kumar S, Shresth A. Evaluation of predictive factors for conversion of laparoscopic cholecystectomy. Kathmandu University Medic J. 2009;7(25):26-30.

Shamin M, Memon AS, Bhutto AA, Dahri MM. Reasons of conversion of laparoscopic to open cholecystectomy in a tertiary care institution. J Pak Med Assoc. 2009;59(7):456-60.