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Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach

Abstract Background

The aim of this study is to compare efficacy and complications between fundus-down and conventional laparoscopic cholecystectomy (LC) in treating contracted gallbladders with gallstones.

Methods

Between January 1999 and May 2008, 64 patients with contracted gallbladders and gallstones were included in the study. Main outcome measures included conversion rate, complication rate, bile duct injury rate, operation time, and postoperative stay.

Results

The average postoperative hospital stay for fundus-down technique was 5 ± 3 days, and 7 ± 3 days for conventional technique (P = 0.003). The conversion rate and complication rate were 0% (0/33) and 3.00% (1/33) for fundus-down technique, and 32.3% (10/31) and 22.6% (7/31) for conventional technique (P = 0.0009 and 0.02, respectively). In subgroup analysis, fundus-down LC seemed to lower the bile duct injury rate from 2/31 (6.5%) to 0/33 (0%) compared with 6/1,468 (0.4%) (P = 0.01 between 6.5% and 0.4% vs. P = 1.00 between 0% and 0.4%).

Conclusions

It appears that fundus-down laparoscopic cholecystectomy is associated with lower conversion and complication rates and shorter postoperative hospital stay as compared with conventional laparoscopic cholecystectomy when used to treat patients with contracted gallbladders and gallstones.

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Acknowledgments

The authors would like to thank Mr. Hsueh-Sheng Lai for his professional sketching of the diagrammatic illustrations in Fig. 3. This study is supported partially by Chung Shan Medical University through grant nos. CSMU-96-OM-B-042, CSMU-TTM-097-001, and CSMU-TTM-098-002.

Author contributions

Study concept and design: Huang SM, Wu CW, Lui WY, Pan H, and Yao CC. Acquisition of data: Huang SM, Yao CC, Wu CW, and Lui WY. Analysis and interpretation of data: Huang SM, Wu CW, Hsiao KM, and Pan HC. Drafting of the manuscript: Huang SM, Yao CC, Wu CW, Chen LY, Hsiao KM, Pan HC, and Lui WY. Critical revision of the manuscript for important intellectual content: Huang SM, Wu CW, Pan H, and Hsiao KM. Statistical analysis: Huang SM, Wu CW, Hsiao KM, and Pan HC. Obtaining funding: Huang SM, Chen LY and Hsiao KM. Administrative, technical, and material support: Huang SM, Chen LY, Hsiao KM, Wu CW, Yao CC, Lai TJ, and Lui WY. Study supervision: Lai TJ and Lui WY.

Disclosures

Authors Shing-Moo Huang, Chung-Chin Yao, Te-Jen Lai, Ling-Yun Chen, Huichin Pan, Kuang-Ming Hsiao, Chew-Wun Wu, and Wing-Yiu Lui have no conflicts of interest or financial ties to disclose.

Author information Authors and Affiliations

  1. Institute and School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China

    Shing-Moo Huang, Chung-Chin Yao & Te-Jen Lai

  2. Department of Life Science, National Chung Cheng University, Minhsiung Chia-Yi, Taiwan, Republic of China

    Kuang-Ming Hsiao

  3. Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China

    Huichin Pan

  4. Department of Biomedical Sciences, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, Taichung, 40201, Taiwan, Republic of China

    Huichin Pan

  5. Division of General Surgery, Department of Surgery, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd, Taichung, 40201, Taiwan, Republic of China

    Shing-Moo Huang & Chung-Chin Yao

  6. Department of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan, Republic of China

    Ling-Yun Chen

  7. Division of General Surgery, Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, Taipei, Taiwan, Republic of China

    Chew-Wun Wu & Wing-Yiu Lui

Authors
  1. Shing-Moo Huang
  2. Kuang-Ming Hsiao
  3. Huichin Pan
  4. Chung-Chin Yao
  5. Te-Jen Lai
  6. Ling-Yun Chen
  7. Chew-Wun Wu
  8. Wing-Yiu Lui
Corresponding authors

Correspondence to Huichin Pan or Chung-Chin Yao.

Additional information

Shing-Moo Huang and Kuang-Ming Hsiao contributed equally to this work.

About this article Cite this article

Huang, SM., Hsiao, KM., Pan, H. et al. Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach. Surg Endosc 25, 284–291 (2011). https://doi.org/10.1007/s00464-010-1175-y

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