Antegrade cholecystectomy before ligating the elements. A technique that reduces complications

Abstract

BACKGROUND: In open surgery, the most common approach is Retrograde approach (“fundus first”), while is less frequent in laparoscopic cholecystectomy. Antegrade access, is obtained by putting in traction the infundibulum and reaching up to the fundus right before clipping the cystic. Our study analyzes a number of surgical procedures performed by surgeons with long experience in laparoscopy.

METHODS: From 2002 to 2017, 2020 laparoscopic cholecystectomies were performed at our Institution. The operative technique used since 2002 is the following: incision of the visceral peritoneum from the infundibulum away from Calot’s triangle along the gallbladder bed up to the fundus and then to the infundibulum.

RESULTS: No bile duct injuries happened. Average operative time was 38 min. 30 conversions to an open procedure (1.5%) occurred, in patients with cholecystitis and cirrhosis Postoperative stay was mean 2 days with no delayed complications on follow up.

CONCLUSIONS: Gallbladder antegrade dissection for laparoscopic cholecystectomy may be an easier approach and may reduce the time of surgery. So it may be used as the standard procedure and not only be used for complicated cholecystectomies.