Laparoscopic cholecystectomy: Fundus first or fundus last-which and why?

Abstract

Biliary tract injury represents the most serious and potentially life-threatening cholecystectomy complication. It is important to identify the structure of Calot's triangle during isolation of cystic duct to decrease this injury. Cystic duct isolation is the first dangerous technique in laparoscopic cholecystectomy. Retrograde (fundus first) dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy, it has not been widely practiced as the antegrade conventional one. This article is presented to show that retrograde method appears to be a safe procedure and does not compromise the conventional one. It should be tried if obscure anatomy should occur without proceeding to irreparable hemorrhage or biliary injury. If these do occur, conversion is always a viable choice and should not be deemed a failure. However, retrograde dissection remains to have its error trap that is mostly leading to vasculobiliary injuries as well as the drawback of retained GB stones tendency. Abbreviations: OC: Open cholecystectomy, LC: Laparoscopic cholecystectomy, RLC: Retrograde laparoscopic cholecystectomy, CLC: Conventional laparoscopic cholecystectomy, GB: Gallbladder, CBD: Common bile duct, CHD: Common hepatic duct, IOC: Intraoperative cholangiography, ERCP: Endoscopic retrograde cholangiopancreaticography. © Jaypee Brothers Medical Publishers (P) Ltd.