Fundus first as the standard technique for laparoscopic cholecystectomy

Yucel Cengiz,Meisam Lund,Arthur Jänes,Leif Israelsson,Lars Lundell,Gabriel Sandblom

doi:10.1038/s41598-019-55401-6

Abstract

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.

Highlights

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation
Patients operated on with the FF technique were more often female, surgery was more often emergent, elective surgery was more often in daycare, dissection was more often with ultrasonic shears, the cystic duct was more often closed with ultrasonic energy and operation time was shorter (Table 1)
With the FF technique a higher proportion were completed in daycare than with the conventional technique

Summary

Introduction

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. Previous studies have shown that the FF technique is cost-effective, simplifies the procedure and facilitates patient rehabilitation[4,6,14,15,16,17], and a possible improved safety profile has been suggested[13,16,18,19,20]. With this background the FF technique was launched as the routine technique for all LC at the department. Mean years (SD) Female Emergent procedure Laparoscopic operation converted into open surgery Daycare in elective surgery Instrument for dissection: Unipolar diathermy Ultrasonic shears Ultrasonic shears closing the cystic duct Operating time, mean minutes (SD)

Objectives

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Results

Conclusion