Tape ligature of cystic duct and fundus-down approach for safety laparoscopic cholecystectomy: outcome of 500 patients.

It is important to identify the structure of Calot's triangle at the time of cystic duct isolation to decrease intraoperative bile duct injury. Isolation of the cystic duct is the first dangerous technique in laparoscopic cholecystectomy. In conventional open cholecystectomy, the fundus-down approach (retrograde) is a more common procedure than the approach in the reverse direction. Similarly, the fundus-down approach is safe and has benefits of reducing common bile duct injury. We report the easy and safe contrivance for laparoscopic cholecystectomy with taping of the cystic duct followed by resection of the gallbladder with the fundus-down approach, performed for 500 patients. The identified cystic duct was ligatured temporarily with Teflon tape. Then, fundus of the gallbladder was isolated with the fundus-down approach except for Calot's triangle. The tape was used for pulling down the cystic duct and Calot's triangle was easily visible. The cystic duct was cut off only after the confirmation of no bile duct injury. Thanks to this tape procedure, there was no bile duct injury in our 500 cases. We recommend this tape ligature of the cystic duct with the fundus-down approach to decrease the incidence of common bile duct injury.