Clinical evaluation of fundus first laparoscopic cholecystectomy in obscured calot’s triangle

Background: During laparoscopic cholecystectomy dissection at the calot’s triangle can be difficult due to dense adhesions, abnormal anatomy or mirizzi’s syndrome. This increases the incidence of bile duct injuries resulting in conversion to open cholecystectomy and increased hospital stay and cost effectiveness and decreases the advantages conferred by laparoscopic cholecystectomy. Fundus first laparoscopic cholecystectomy offers the advantage of laparoscopic surgery without any increase in the incidence of bile duct injuries. This study was done to evaluate and observe the complications and clinical outcome of fundus first laparoscopic cholecystectomy. Material Methods: The prospective study was conducted on 30 patients undergoing fundus first laparoscopic cholecystectomy over a period of one year. Approval for the study was obtained from the institutional ethical committee. During laparoscopic cholecystectomy where ever the calot’s triangle was found obscured, the decision of performing laparoscopic cholecystectomy using the fundus first technique was taken. Intraoperative and postoperative observations were made and complications were noted. Results: Fundus First Laparoscopic cholecystectomy was done in 30 patients among 138 patients undergoing Laparoscopic cholecystectomy. 73% of our patients had marked fibrosis at cystic pedicle. Operating time in our cases ranged from 80 to 140 minutes (mean, 106.73 ± 16.85 minutes). We observed a mean hospital stay of 7.70 ± 2.55 days in present study (range, 5 - 15 days). We had two cases of External biliary fistula due to leakage from stump and got settled with endoscopic retrograde cholangiopancreatography (ERCP) stenting. We had port site infection in 3 cases and drain site infection in 2 cases. Conclusion: Fundus first laparoscopic cholecystectomy is a better alternative and a bail out procedure in difficult cholecystectomy reducing incidence of bile duct injuries and offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectom