Abstract
AbstractIn previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Berci, G. et al. Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surgical endoscopy 27, 1051–1054 (2013).
2. Saia, M. et al. Time trend and variability of open versus laparoscopic cholecystectomy in patients with symptomatic gallstone disease. Surgical endoscopy 27, 3254–3261 (2013).
3. Neugebauer, E. et al. The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements–September 1994. The Educational Committee of the European Association for Endoscopic. Surgery. Surgical endoscopy 9, 550–563 (1995).
4. Eikermann, M. et al. Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surgical endoscopy 26, 3003–3039 (2012).
5. Overby, D. W. et al. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surgical endoscopy 24, 2368–2386 (2010).
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