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Impact of fundus-first laparoscopic cholecystectomy for severe cholecystitis

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Abstract

Background

The Tokyo Guidelines 2018 proposed fundus-first laparoscopic cholecystectomy (FFLC) as a bailout surgery. This study investigated the clinical impact of FFLC for severe cholecystitis.

Methods

This study reviewed 772 patients who underwent laparoscopic cholecystectomy (LC) between 2015 and 2018. Of these patients, 171 patients were diagnosed with severe cholecystitis according to our difficulty scoring system. FFLC was not prevalent in our faculty for the first 2 years [early period group (EG)], whereas FFLC was predominantly used for the last 2 years [late period group (LG)]. There were 81 patients (47%) belonging to the EG and 90 patients (53%) in the LG. The clinical data and the surgical outcomes of these patients were retrospectively analyzed.

Results

The difficulty score did not differ between the two groups (11 vs. 11 points, p = 0.846). Patients underwent FFLC significantly more frequently in the LG (63% vs. 12%, p = 0.020). Laparoscopic subtotal cholecystectomy (LSC) was done in 10 patients (11%) of the LG, which was significantly low compared to that in the EG (n = 20, 25%) (p = 0.020). In all patients, LC was safely achieved without bile duct injury or conversion to laparotomy. The incidence of choledocholithiasis was significantly low in the LG (0 vs. 4, p = 0.048). The median postoperative hospital stay was significantly shorter in the LG (6 vs. 4 days, p < 0.001).

Conclusion

After the introduction of FFLC, there were significant improvements in the surgical outcomes of LC for severe cholecystitis, including the rate of LSC, incidence of choledocholithiasis, and duration of postoperative hospital stay.

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Authors and Affiliations

  1. Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Takaaki Osawa, Yasuyuki Fukami, Shunichiro Komatsu, Takuya Saito, Tatsuki Matsumura, Shintaro Kurahashi, Tairin Uchino, Shoko Kato, Kenitiro Kaneko & Tsuyoshi Sano

Authors
  1. Takaaki Osawa
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  2. Yasuyuki Fukami
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  3. Shunichiro Komatsu
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  4. Takuya Saito
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  5. Tatsuki Matsumura
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  6. Shintaro Kurahashi
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  7. Tairin Uchino
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  8. Shoko Kato
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  9. Kenitiro Kaneko
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  10. Tsuyoshi Sano
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Corresponding author

Correspondence to Takaaki Osawa.

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Disclosures

Takaaki Osawa, Yasuyuki Fukami, Shunichiro Komatsu, Takuya Saito, Tatsuki Matsumura, Shintaro Kurahashi, Tairin Uchino, Shoko Kato, Kenitiro Kaneko and Tsuyoshi Sano have no conflicts of interest to declare.

Ethical approval

This study was approved by the Institutional Review Board of the Aichi Medical University (No. 2019-081) and is in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All patients provided signed informed consent before undergoing therapy

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Osawa, T., Fukami, Y., Komatsu, S. et al. Impact of fundus-first laparoscopic cholecystectomy for severe cholecystitis. Surg Endosc 37, 6129–6134 (2023). https://doi.org/10.1007/s00464-023-10080-3

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  • DOI: https://doi.org/10.1007/s00464-023-10080-3

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