Bhoopathy Gaurav, Priyadarshini Monali, Hota Debendra K, Sahoo Saroj K
Department of General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2024 Nov 30;16(11):e74842. doi: 10.7759/cureus.74842. eCollection 2024 Nov.
Laparoscopic cholecystectomy is a standard minimally invasive technique for the treatment in gallstone disease. In difficult laparoscopic cholecystectomies, bailout strategies have been developed of which the fundus-first technique is one. The present study aims to compare the outcomes of the fundus-first technique against the standard laparoscopic approach in managing difficult cholecystectomy cases by focusing on intraoperative factors such as bleeding, bile duct injury, operative time, and postoperative complications like biliary leakage.
A prospective comparative study was conducted over a period of two years (June 2022-May 2024) with 200 consecutive patients. All patients were classified as difficult cases based on the Tokyo 2018 guidelines. Detailed data collection included patient history, physical examination, laboratory investigations, and operative findings. The study's follow-up period was six weeks.
The fundus-first technique demonstrated significant advantages, with a reduction in operative time, fewer intraoperative complications, and better operative outcomes compared to the standard approach. Patients in the fundus-first group had a mean operative time of 91.50 minutes as compared to 143.75 minutes in the standard group (p < 0.001) and 88% completed operative outcome vs 51%(p < 0.001). No significant differences were observed in postoperative complications such as bile leakage and bleeding between the two groups.
The fundus-first technique offers a safer and more efficient alternative to the standard approach in difficult laparoscopic cholecystectomy cases. By allowing better access to Calot's triangle, this method proves to be an effective bailout strategy, despite its steep learning curve. Further studies are needed to validate these findings and explore the broader application of the fundus-first technique in gallbladder surgeries.
腹腔镜胆囊切除术是治疗胆结石疾病的标准微创手术技术。在困难的腹腔镜胆囊切除术中，已制定了多种补救策略，其中从底部开始的技术是其中之一。本研究旨在通过关注术中因素（如出血、胆管损伤、手术时间）以及术后并发症（如胆漏），比较从底部开始的技术与标准腹腔镜手术方法在处理困难胆囊切除病例中的效果。
在两年时间（2022年6月至2024年5月）内对200例连续患者进行了一项前瞻性对照研究。根据2018年东京指南，所有患者均被归类为困难病例。详细的数据收集包括患者病史、体格检查、实验室检查和手术结果。该研究的随访期为六周。
与标准方法相比，从底部开始的技术显示出显著优势，手术时间缩短，术中并发症减少，手术效果更好。从底部开始的技术组患者的平均手术时间为91.50分钟，而标准组为143.75分钟（p<0.001），手术成功完成率分别为88%和51%（p<0.001）。两组之间在术后并发症如胆漏和出血方面未观察到显著差异。
在困难的腹腔镜胆囊切除病例中，从底部开始的技术为标准方法提供了一种更安全、更有效的替代方案。通过更好地进入胆囊三角区，该方法被证明是一种有效的补救策略，尽管其学习曲线较陡。需要进一步的研究来验证这些发现，并探索从底部开始的技术在胆囊手术中的更广泛应用。
