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Is fundus first laparoscopic cholecystectomy a better option than conventional laparoscopic cholecystectomy for difficult cholecystectomy? A systematic review and meta-analysis

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Abstract

The gallstone disease prevalence is up to 27% in the general adult population. Though most of the patients are asymptomatic, about 1–4% of these patients became symptomatic every year and will require treatment. Fundus first laparoscopic cholecystectomy (FFLC) was first reported by Cooperman in 1990 when he utilized the approach to safely perform LC for patients with acute cholecystitis and dense adhesion around the calot’s triangle which precluded safe dissection. Some surgeons reported that the FFLC may be quicker than the traditional dissection starting at the Calot’s triangle, although no randomized trial has been undertaken to confirm that. We aim to perform this systematic review and meta-analysis to compare outcome of fundal first laparoscopic cholecystectomy with conventional laparoscopic cholecystectomy. Three reviewers independently searched the Pubmed, medline, google schoolar, Cochrane library and Embase databases for prospective or retrospective articles comparing outcomes of fundus first LC and conventional LC. The search terms were “retrograde cholecystectomy”, “antegrade cholecystectomy”, “fundus first cholecystectomy”, “fundus down cholecystectomy”, and “dome down cholecystectomy”. Studies were selected based on predetermined criteria and data were extracted from the study for meta-analysis. Twelve studies were included for meta-analysis. Our analysis revealed that FFLC is associated with less conversion to open surgery, less time of surgery, less risk of bile duct injuries and shorter duration of hospital stay compared conventional cholecystectomy in patients with difficult cholecystectomy. In conclusion, fundus first laparoscopic cholecystectomy is a safer alternative to conventional laparoscopic cholecystectomy in patients with difficult cholecystectomy.

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Abbreviations

FFLC:

Fundus first laparoscopic cholecystectomy

CLC:

Conventional laparoscopic cholecystectomy

BDI:

Bile duct injury

CVS:

Critical view of safety

References

  1. Shabanzadeh DM (2018) Incidence of gallstone disease and complications. Curr Opin Gastroenterol 34(2):81–89

    Article  PubMed  Google Scholar 

  2. Pisano M, Allievi N, Gurusamy K et al (2020) 2020 world society of emergency surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 15(1):1–26

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chaudhary S (2020) Epidemiology of gall stone diseases among patients attending surgical department of a tertiary care hospital in Nepal. Janaki Med Coll J Med Sci 8(1):50–55

    Article  Google Scholar 

  4. Singh K, Thaker BD, Kachroo SL (2015) A profile of fundus first laparoscopic cholecystectomy. JK Sci 17(1):33–46

    Google Scholar 

  5. Gupta A, Agarwal PN, Kant R et al (2004) Evaluation of fundus-first laparoscopic cholecystectomy. JSLS 8(3):255–258

    PubMed  PubMed Central  Google Scholar 

  6. Kelly MD (2009) Laparoscopic retrograde (fundus first) cholecystectomy. BMC Surg 9(1):1–8

    Article  Google Scholar 

  7. Algalaly N (2014) Laparoscopic cholecystectomy fundus first. J Am Sci 10(12):205–209

    Google Scholar 

  8. Strasberg SM (2019) A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci 26(4):123–127

    Article  PubMed  Google Scholar 

  9. Rosenberg J, Leinskold T (2004) Dome down laparosonic cholecystectomy. Scand J Surg 93(1):48–51

    Article  PubMed  CAS  Google Scholar 

  10. Tuveri M, Calò PG, Medas F et al (2008) Limits and advantages of fundus-first laparoscopic cholecystectomy: lessons learned. J Laparoendosc Adv Surg Tech 18(1):69–75

    Article  Google Scholar 

  11. Blum C, Adams D (2011) Who did the first laparoscopic cholecystectomy. J Minim Access Surg 7(3):165–168

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reynolds W (2001) The first laparoscopic cholecystectomy. JSLS 5(1):89–94

    PubMed  PubMed Central  Google Scholar 

  13. Schwesinger WH, Diehl AK (1996) Changing indications for laparoscopic cholecystectomy: stones without symptoms and symptoms without stones. Surg Clin North Am 76(3):493–504

    Article  PubMed  CAS  Google Scholar 

  14. Kapoor VK (2016) Medico-legal aspects of bile duct injury. J Minim Access Surg 12(1):1–3

    Article  PubMed  PubMed Central  Google Scholar 

  15. Flum DR, Koepsell T, Heagerty P et al (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136(11):1287–1292

    Article  PubMed  CAS  Google Scholar 

  16. Christou N, Roux-David A, Naumann DN et al (2021) Bile duct injury during cholecystectomy: necessity to learn how to do and interpret intraoperative cholangiography. Front Med 8(February):1–11

    Google Scholar 

  17. Kaya B, Fersahoglu MM, Kilic F et al (2017) Importance of critical view of safety in laparoscopic cholecystectomy: a survey of 120 serial patients, with no incidence of complications. Ann Hepato-Biliary-Pancreatic Surg 21(1):17

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sgaramella LI, Gurrado A, Pasculli A et al (2021) The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study Surg Endosc 35(7):3698–3708

    PubMed  Google Scholar 

  19. Pucher PH, Brunt LM, Fanelli RD et al (2015) SAGES expert delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 29(11):3074–3085. https://doi.org/10.1007/s00464-015-4079-z

    Article  PubMed  Google Scholar 

  20. Strasberg SM, Brunt LM (2017) The critical view of safety. Ann Surg 265(3):464–465

    Article  PubMed  Google Scholar 

  21. Conrad C, Wakabayashi G, Asbun HJ et al (2017) IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 24(11):603–615

    Article  PubMed  Google Scholar 

  22. Sari YS, Tunali V, Tomaoglu K et al (2005) Can bile duct injuries be prevented? “A new technique in laparoscopic cholecystectomy.” BMC Surg 5:4–7

    Article  Google Scholar 

  23. Cooperman AM (1990) Laparoscopic cholecystectomy for severe acute, embedded, and gangrenous cholecystitis. J Laparoendosc Surg 1(1):37–40

    Article  PubMed  CAS  Google Scholar 

  24. Martin IG, Dexter SPL, Marton J et al (1995) Fundus-first laparoscopic cholecystectomy. Surg Endosc 9:203–206

    Article  PubMed  CAS  Google Scholar 

  25. Mishra BM, Guru RN, Kar SK (2019) Advantage of fundus first method over conventional approach in difficult laparoscopic cholecystectomy: a prospective study. Int Surg J 6(5):1613

    Article  Google Scholar 

  26. Cengiz Y, Lund M, Jänes A et al (2019) Fundus first as the standard technique for laparoscopic cholecystectomy. Sci Rep 9(1):1–6

    Article  Google Scholar 

  27. Reed DA, Cook DA, Beckman TJ et al (2008) Association between funding and quality of published medical education research. Prim Care 298(9):1002–1009

    Google Scholar 

  28. Saeed AB, Jamal A, Jameel MK et al (2020) Comparison of fundus-first dissection versus conventional dissection in laparoscopic cholecystectomy. Pakistan J Med Heal Sci 14(2):329–331

    Google Scholar 

  29. Cengiz Y, Dalenbäck J, Edlund G et al (2010) Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial. Surg Endosc 24(3):624–630

    Article  PubMed  Google Scholar 

  30. Tuveri M, Borsezio V, Calò PG et al (2009) Laparoscopic cholecystectomy in the obese: results with the traditional and fundus-first technique. J Laparoendosc Adv Surg Tech 19(6):735–740

    Article  Google Scholar 

  31. Sormaz İC, Soytaş Y, Gök AFK et al (2018) Fundus-first technique and partial cholecystectomy for difficult laparoscopic cholecystectomies. Ulus Travma ve Acil Cerrahi Derg 24(1):66–70

    Google Scholar 

  32. Neri V, Ambrosi A, Fersini A et al (2007) Antegrade dissection in laparoscopic cholecystectomy. JSLS 11(2):225–228

    PubMed  PubMed Central  Google Scholar 

  33. Huang SM, Hsiao KM, Pan H et al (2011) Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach. Surg Endosc 25(1):284–291

    Article  PubMed  CAS  Google Scholar 

  34. Sewefy AM, Hassanen AM, Atyia AM et al (2017) Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases. Int J Surg 43:75–80. https://doi.org/10.1016/j.ijsu.2017.05.044

    Article  PubMed  Google Scholar 

  35. Cengiz Y, Jänes A, Grehn Å et al (2005) Randomized clinical trial of traditional dissection with electrocautery versus ultrasonic fundus-first dissection in laparoscopic cholecystectomy. Br J Surg 92(7):810–813

    Article  PubMed  CAS  Google Scholar 

  36. Tudu D, Mishra BB (2019) Prediction of difficult cholecystectomy, a study of 100 cases. Int J Res Med Sci 7(1):63–66

    Article  Google Scholar 

  37. El Boghdady M, Arang H, Ewalds-Kvist BM (2022) Fundus-first laparoscopic cholecystectomy for complex gallbladders: a systematic review. Heal Sci Rev. 2(January):100014. https://doi.org/10.1016/j.hsr.2022.100014

    Article  Google Scholar 

  38. Briggs CD, Irving GB, Mann CD et al (2009) Introduction of a day-case laparoscopic cholecystectomy service in the UK : a critical analysis of factors influencing same-day discharge and contact with primary care providers. Ann R Coll Surg Engl 91:583–590

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Rosen MJ, Malm JA, Tarnoff M et al (2001) Cost-effectiveness of ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 11(3):182–184

    Article  PubMed  CAS  Google Scholar 

  40. Akoh JA, Watson WA, Bourne TP (2011) Day case laparoscopic cholecystectomy: reducing the admission rate. Int J Surg 9(1):63–67. https://doi.org/10.1016/j.ijsu.2010.09.002

    Article  PubMed  Google Scholar 

  41. Reddick EJ (1992) Laparoscopic cholecystectomy in freestanding outpatient centers. J Laparoendosc Surg 2(2):158–160

    Article  Google Scholar 

  42. Hakeem AR, Oswald N, Di FF et al (2018) ‘ True day case’ laparoscopic cholecystectomy in a high-volume specialist unit and review of factors contributing to unexpected overnight stay. Hindawi Minim Invasive Surg. https://doi.org/10.1155/2018/1260358

    Article  Google Scholar 

  43. Ghnnam WM, Elsaid M, Ellatif A et al (2017) Laparoscopic cholecystectomy as a day surgery operation: two centers experience. Int J Surg Med 3(2):90–95

    Article  Google Scholar 

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Funding

No fundıng was gotten for thıs review.

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Authors and Affiliations

  1. Ammu Kano Teachıng Hospital, Kano, Nigeria

    Ibrahım Umar Garzali

  2. King Hussein Medical Center, Amman, Jordan

    Anas Aburumman, Yousef Alsardia, Belal Alabdallat, Saad Wraikat & Ali Aloun

Authors
  1. Ibrahım Umar Garzali
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  2. Anas Aburumman
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  3. Yousef Alsardia
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  4. Belal Alabdallat
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  5. Saad Wraikat
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  6. Ali Aloun
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Contributions

Concept—AA, AA AND IUG; design—BA, YA AND SW; supervision—AA, SW AND IUG; resources—ALL; materials—ALL; data collection and/or processing—IUG, AA AND BA; analysis and/or ınterpretation—AA, YA AND SW; literature search—IUG, AA AND BA; writing manuscript—ALL; critical review—IUG AND AA; other—XX.

Corresponding author

Correspondence to Ali Aloun.

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Not needed as this is a systematic review and meta-analysis.

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This is a meta-analysis of previously published studies, no humans or animals were used for the research. As such, this disclosure in not available.

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Garzali, I.U., Aburumman, A., Alsardia, Y. et al. Is fundus first laparoscopic cholecystectomy a better option than conventional laparoscopic cholecystectomy for difficult cholecystectomy? A systematic review and meta-analysis. Updates Surg 74, 1797–1803 (2022). https://doi.org/10.1007/s13304-022-01403-5

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  • DOI: https://doi.org/10.1007/s13304-022-01403-5

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