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Fundus First Method with Catgut Loop for Ligation of Cystic Artery and Duct Stump: An Alternative Technique to Conversion in Difficult Laparoscopic Cholecystectomy

Lokesh C., Assistant Professor, Department of Radiodiagnosis, PK Das Institute of Medical sciences, Vaniamkulam, Palaghat, Kerala 682522, India. , Dinesh Babu M.V.a , Lokesh C.b , P.R. Venu Gopalc

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New Indian Journal of Surgery 8(4):p 571-574, Oct-Dec 2017. | DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8417.21

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Abstract

Background: Laparoscopic cholecystectomy is now accepted worldwide as the gold standard surgical technique for cholecystitis. But it is not without difficulties especially in a/c cases.Here we discuss about our experience in difficult cholecystectomy which we managed with fundus first method especially when it is difficult to dissect out cystic artery and duct at calot’s triangle due to dense adhesions. After dissecting fundus, body and neck catgut loops were used to tie the cystic pedicle.

Methods: 100 cases of laparoscopic cholecystectomy done in patients presented with abdominal pain and USG diagnosis of cholecystitis. The cases were analysed prospectively with data sheets and video recordings over a period of 18 months. The period of study and the 100 cases were selected for statistical significance. Among those 28 cases were done with fundus first technique and out of these 22 cases were with catgut loop tie technique.

Results: Conversion rate was 0% and there was no CBD injury. On follow up two cases had problems one with retained stones in CBD and other in the cystic duct. One case was managed with endoscopic sphincterotomy and the other case with laparoscopy.

Conclusion: Fundus first method with catgut loop tie of cystic pedicle with frozen calot’s and thickened cystic duct stump is an alternative technique for conversion to open surgery in difficult cholecystectomy. It is a safe technique with decreased post–operative morbidity.

 

 

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.8417.21

Keywords

Fundus First; Laparoscopic Cholecystectomy; Retrograde Technique; Cystic Duct Stump Ligation; A/C Cholecystitis; Frozen Calot’s Triangle; CBD Injury. 

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