DOI: http://dx.doi.org/10.18203/2349-2902.isj20204674

Our experience with retrograde technique in difficult laparoscopic cholecystectomy

Vamsi K. Malligurki

Abstract


Background: Gall bladder pathologies are some of the commonly encountered conditions in one’s surgical practice. Cholecystectomy is among the routinely performed procedures in most surgical units. Laparoscopic surgery is preferred to open cholecystectomy because of its various advantages. In straightforward cases, the antegrade technique is routinely employed. The retrograde technique is generally reserved for the difficult cases. The retrograde technique may be used safely with adequate experience, thus reducing the need for conversion into open surgery.

Methods: Total 100 cases of consecutive difficult laparoscopic cholecystectomies were included in this study, which were operated using retrograde technique.

Results: Out of the 100 patients 79 were females and 21 were males. Mean age of the patients was 44.2 years. Out of the 100 cases, 98 cases could be successfully managed using the retrograde technique. 2 cases were converted to open surgery. Bleeding was encountered in 3 cases, which was successfully managed laparoscopically. Bile duct injury was seen in 1 case which was managed after conversion.

Conclusions: With adequate surgical expertise and proper instrumentation, retrograde dissection technique may be safely used in difficult laparoscopic cholecystectomy, reducing the rate of conversion to open surgery.


Keywords


Difficult laparoscopic cholecystectomy, Retrograde dissection, Fundus first method

Full Text:

PDF

References


Sormaz IC, Soytaş Y, Gök AF, Özgür İ, Avtan L. Fundus-first technique and partial cholecystectomy for difficult laparoscopic cholecystectomies. Ulus Travma Acil Cerrahi Derg. 2018;24(1):66-70.

Cengiz Y, Lund M, Jänes A, Lundell L, Sandblom G, Israelsson L. Fundus first as the standard technique for laparoscopic cholecystectomy. Scientific Reports. 2019;9(1):1-6.

Michael D Kelly. Laparoscopic retrograde (fundus first) cholecystectomy. Brt Mrd Centr Surg. 2009;9:19

Sugrue M, Sahebally SM, Ansaloni L, Zielinski MD. Grading operative findings at laparoscopic cholecystectomy-a new scoring system. Wor J Emergen Surg. 2015;10(1):14.

Griffiths EA, Hodson J, Vohra RS, Marriott P, Katbeh T, Zino S, Nassar AH, West Midlands Research Collaborative. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Rndosc. 2019;33(1):110-21.

Gupta N, Ranjan G, Arora MP, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013;11(9):1002-6.

Kato K, Kasai S, Matsuda M, Onodera K, Kato J, Imai M, et al. A new technique for laparoscopic cholecystectomy-retrograde laparoscopic cholecystectomy: an analysis of 81 cases. Endosco. 1996;28(04):356-9.

Hussain A. Difficult Laparoscopic Cholecystectomy: Current Evidence and Strategies of Management. Surg Laparosc Endosc Percutan Tech. 2011;21(4)

Tuveri M, Calo PG, Medas F, Tuveri A, Nicolosi A. Limits and advantages of fundus-first laparoscopic cholecystectomy: lessons learned. J Laparoendosco Advanc Surg Techniq. 2008;18(1):69-75.