Five cases of "fundus first" laparoscopic cholecystectomy were studied. There is controversy about using fundus first technique in dissecting the gallbladder in both open and laparoscopic surgery.
The indication for using this technique was due to the inability to start dissection in Calot's Triangle safely, because of its obscure anatomy, inability to retract the liver up in cases of cirrhotic liver, big empyema of the gallbladder and reduced peritoneal cavity in obese patients. The average operative time was 110 minutes. No mortality or morbidity were recorded apart from one case of postoperative obstructive jaundice released by ERCP sphincterotomy. It was concluded that with appropriate experience "fundus first" laparoscopic cholecystectomy can be done safely in difficult laparoscopic cholecystectomy when indicated. But no structure should not be divided before the clear dissection of the cystic duct and artery
Mohamed Y. EzzEl Din ,
Fundus first laparoscopic cholecystectomy,
Med. J. Cairo Univ. 1994;
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