title: Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach.
abstract: BACKGROUND
  The aim of this study is to compare efficacy and complications between fundus-down and conventional laparoscopic cholecystectomy (LC) in treating contracted gallbladders with gallstones.
  
  
  METHODS
  Between January 1999 and May 2008, 64 patients with contracted gallbladders and gallstones were included in the study. Main outcome measures included conversion rate, complication rate, bile duct injury rate, operation time, and postoperative stay.
  
  
  RESULTS
  The average postoperative hospital stay for fundus-down technique was 5 ± 3 days, and 7 ± 3 days for conventional technique (P = 0.003). The conversion rate and complication rate were 0% (0/33) and 3.00% (1/33) for fundus-down technique, and 32.3% (10/31) and 22.6% (7/31) for conventional technique (P = 0.0009 and 0.02, respectively). In subgroup analysis, fundus-down LC seemed to lower the bile duct injury rate from 2/31 (6.5%) to 0/33 (0%) compared with 6/1,468 (0.4%) (P = 0.01 between 6.5% and 0.4% vs. P = 1.00 between 0% and 0.4%).
  
  
  CONCLUSIONS
  It appears that fundus-down laparoscopic cholecystectomy is associated with lower conversion and complication rates and shorter postoperative hospital stay as compared with conventional laparoscopic cholecystectomy when used to treat patients with contracted gallbladders and gallstones.
authors.affiliation: Institute and School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China. shingmooeel@yahoo.com.tw
authors.forename: Shing-Moo
authors.initials: SM
authors.lastname: Huang
authors.forename: Kuang-Ming
authors.initials: KM
authors.lastname: Hsiao
authors.forename: Huichin
authors.initials: H
authors.lastname: Pan
authors.forename: Chung-Chin
authors.initials: CC
authors.lastname: Yao
authors.forename: Te-Jen
authors.initials: TJ
authors.lastname: Lai
authors.forename: Ling-Yun
authors.initials: LY
authors.lastname: Chen
authors.forename: Chew-Wun
authors.initials: CW
authors.lastname: Wu
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
mesh_terms: D001652:Bile Ducts / Q000293:injuries; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology*; D005748:Gastric Fundus; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography