Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 1/2011

01-01-2011

Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach

Authors: Shing-Moo Huang, Kuang-Ming Hsiao, Huichin Pan, Chung-Chin Yao, Te-Jen Lai, Ling-Yun Chen, Chew-Wun Wu, Wing-Yiu Lui

Published in: Surgical Endoscopy | Issue 1/2011

Login to get access

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.
Literature
1.
Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 211:60–62CrossRefPubMed
2.
Reddick EJ (1990) Laparoscopic laser cholecystectomy: the first 50 cases. Laser Surg Med 10(suppl 2): 21
3.
Cuschieri A, Berci G, McSherry CK (1990) Laparoscopic cholecystectomy. [Editorial] Am J Surg 159:273CrossRefPubMed
4.
Zucker KA, Bailey RW, Gadacz TR, Imbembo AL (1991) Laparoscopic guided cholecystectomy. Am J Surg 161:36–44CrossRefPubMed
5.
Huang SM, Wu CW, Lui WY, P’eng FK (1996) A prospective randomized study of laparoscopic versus open cholecystectomy in aged patient with cholecystolithiasis. South Afr J Surg 34(4):177–180
6.
Huang SM, Wu CW, Hong HT, Liu M, King KL, Lui WY (1993) Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 80:1590–1592CrossRefPubMed
7.
Blumgart LH, Hann LE (2000) Surgical and radiologic anatomy of the liver and biliary tract. In: Blumgart LH, Fong Y (eds) Surgery of the liver and biliary tract, vol 1, 3rd edn. Saunders, WM, p 19
8.
Kanua NA, Doganay M, Dolapei M, Reis E, Atli M, Kologlu M (2001) Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 15:965–968CrossRef
9.
Ball CG, McLean AR, Kirkpatrick AW, Batbe OF, Sutherland F, Debru E, Dixon E (2006) Hepatic vein injury during laparoscopic cholecystectomy—the unappreciated proximity of the middle hepatic vein to the gallbladder bed. J Gastrointest Surg 10(8):1151–1155CrossRefPubMed
10.
Martin IG, Dexter SP, Marton J, Gibson J, Asker J, Firullo A, McMahon MJ (1995) Fundus first laparoscopic cholecystectomy. Surg Endosc 9:203–206CrossRefPubMed
11.
Uyama I, Iida S, Ogiwara T, Takahara T, Kato Y, Furuta T, Kikuchi K (1995) Laparoscopic cholecystectomy (from fundus downward) facilitated by lifting the liver bed up to the diaphragm for inflammatory gallbladder. Surg Laparosc Endosc 6:431–436
12.
Kato K, Matsuda M, Onodera K, Kobayashi T, Kasai S, Mito M (1994) Laparoscopic cholecystectomy from fundus downward. Surg Laparosc Endosc 5:373–374
13.
Kato K, Kasai S, Matsuda M, Onodera K, Kato J, Imai M, Muito M, Saito T (1996) A new technique for laparoscopic cholecystectomy-retrograde laparoscopic cholecystectomy: an analysis of 81 cases. Endoscopy 28:356–359CrossRefPubMed
14.
Geis (2000) Re-engineering laparoscopic cholecystectomy. Surg Rounds 23(3)(suppl):3–9
15.
Raj PK, Castillo G, Urban L (2001) Laparoscopic cholecystectomy: fundus-down approach. J Laparoendosc Adv Surg Tech 11(2):95–100CrossRef
16.
Ichihara T, Takada M, Ajiki T, Fukumoto S, Urakawa T, Nagahata Y, Kuroda Y (2004) Tape ligature of cystic duct and fundus-down approach for safety laparoscopic cholecystectomy: outcome of 500 patients. Hepatogastroenterology 51:362–364PubMed
17.
Raptopoulos V, D’Ors C, Smith E, Reuter K, Moss L, Kleinman P (1982) Dynamic cholecystosonography of contracted gallbladder—the double-arc-shadow sign. AJR 138:275–278PubMed
18.
McDonald FL, Cooperberg PL, Cohen MM (1981) The WES triad—a specific sonographic sign of gallstones in the contracted gallbladder. Gastrointest Radiol 6(1):39–41CrossRef
19.
Huang SM, Wu CW, Hong HT, Liu M, King KL, Lui WY (1993) Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 80:1590–1592CrossRefPubMed
20.
Brune IB, Schonleben K, Omran S (1994) Complications after laparoscopic and conventional cholecystectomy: a comparative study. HPB Surg 8:19–25CrossRefPubMed
21.
Kumar A, Thombare MM, Sikora SS, Saxena R, Kapoor VK, Kaushik SP (1996) Morbidity and mortality of laparoscopic cholecystectomy in an institutional setup. J Laparoendosc Surg 6:393–397PubMed
22.
Vazquez R (2008) Common sense and common bile duct injury: common bile duct injury revisited. Surg Endosc 22:1743–1745CrossRefPubMed
23.
Jones-Monahan K, Gruenberg JC (1998) Bile duct injuries during laparoscopic cholecystectomy: a community’s experience. Am Surg 64:636–642
24.
Windsor JA, Pong J (1998) Laparoscopic biliary injury: more than a learning curve problem. Aust N Z J Surg 68:186–189CrossRefPubMed
25.
Solheim K, Buanes T (1995) Bile duct injury in laparoscopic cholecystectomy. Int Surg 80:361–364PubMed
26.
27.
Van Landingham SB, Broders CW (1982) Gallstone ileus. Surg Clin Am 62:241–247
28.
Metadata
Title
Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach
Authors
Shing-Moo Huang
Kuang-Ming Hsiao
Huichin Pan
Chung-Chin Yao
Te-Jen Lai
Ling-Yun Chen
Chew-Wun Wu
Wing-Yiu Lui
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1175-y

Other articles of this Issue 1/2011

Surgical Endoscopy 1/2011 Go to the issue

OriginalPaper

Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

OriginalPaper

Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature

OriginalPaper

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy

OriginalPaper

Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes

New Technology

Durability of the self-approximating translumenal access technique (STAT) for potential use in natural orifice translumenal surgery (NOTES)

Letter

Comparative-effectiveness research and good clinical practice for laparoscopic rectal surgery after neoadjuvant treatment