Laparoscopic Cholecystectomy: Fundus-Down Approach

Background and Purpose: Laparoscopic cholecystectomy (LC) is the primary treatment of gallstone disease. Although refinements have made it safer, bile duct injury remains more common than with the open approach. The major difference in these techniques is that open cholecystectomy approaches the gallbladder from the fundus downward, whereas conventional laparoscopic cholecystectomy proceeds in the reverse direction. A handful of fundus-down techniques appear in the literature. The use of special instruments or port sites is common. We present a technique that is safe and utilizes instruments familiar to the surgeon performing conventional LC. Patients and Methods: Fifty consecutive LCs were included in the study. The variables monitored were age, comorbidities, postoperative diagnosis, pathologic diagnosis, length of operation, hospital length of stay, and complications. Results: The average operating time for chronic cholecystitis was 1 hour, and the average time for acute cholecystitis was less than 2 h...