Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach.
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.
Huang
Shing-Moo
SM
Institute and School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China. shingmooeel@yahoo.com.tw
Hsiao
Kuang-Ming
KM
Pan
Huichin
H
Yao
Chung-Chin
CC
Lai
Te-Jen
TJ
Chen
Ling-Yun
LY
Wu
Chew-Wun
CW
Lui
Wing-Yiu
WY
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