Laparoscopic modified fundus-down cholecystectomy technique: an alternative method for performing a safe laparoscopic cholecystectomy: how to article

Background: Modified fundus-down cholecystectomy is a surgical procedure used to treat patients diagnosed with benign gallbladder disease. This technique begins with Calot’s triangle dissection and attempts to identify key structures such as the cystic artery and duct. Subsequently, fundus-down dissection is performed to separate the gallbladder from the cystic plate. The cystic artery and duct are the final structures that are clipped and cut. In this study, the authors discuss the success and complication rates of this treatment based on their 10-year experience at a tertiary hospital in southern Thailand. Objectives: This study aimed to compare the operative outcomes of conventional laparoscopic cholecystectomy (LC) and modified fundus-down techniques regarding postoperative complications and consequences. Methods: A retrospective analysis of single-centre data from 2010 to 2022 was conducted at our hospital. All patients with gallstone disease who underwent conventional LC or modified fundus-down cholecystectomy were included in the study. The primary outcomes of this study were the incidence of major bile duct injury and the need for further intervention or surgical correction. Results: From a total of 1993 patients who were surveyed, 1612 patients underwent conventional LC and 381 underwent laparoscopic modified fundus-down cholecystectomy. In terms of conversion rate, estimated blood loss, length of hospital stay, and complication rate, there were no differences between the conventional LC and the modified fundus-down approach. However, modified fundus-down cholecystectomy reduced the operative time. The authors collected data from each patient’s sign-in to extubation time (P<0.001). The postoperative complications (P=0.120) and conversion rates (P=0.904) were similar. Conclusion: Laparoscopic modified fundus-down cholecystectomy can be performed in simple and complex cases, including cases of severe fibrosis of the hepatocystic triangle. The study showed that this alternative technique could reduce operative time compared to the conventional technique with no difference in complications, especially common bile duct injury, postoperative common bile duct stones, and postoperative pancreatitis.