Cholecystectomy : Fundus to Porta Approach

Abstract

Cholecystectomy is a commonly performed operation but there is still controversy whether dissection of the gall bladder should proceed from the fundus to the cystic duct or in the opposite direction. In usual practice the fundus-first method is adopted whenever difficulty is encountered in visualizing the anatomy of the cystic duct and Calot's triangle. Akhough haemorrhage is a little greater than with the duct-first method the risk of damage to the common bile duct or right hepatic artery is minimized. This article describes a brief experience with thirty randomized patients in whom cholecystectomies were performed with planned fundus-first approach. MJAFI 1996; 52 : 79-82

When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy

“…This approach is associated with higher blood loss due to the patency of the cystic artery, which is clipped only at the end of the mobilisation. Before any attempt to expose anatomical landmarks, adhesions should be lysed bluntly, sharply, or using electrocautery [ 55 ].…”