ABSTRACT

Aim: To compare the outcome of the fundus-first dissection versus conventional dissection with electrocautery in laparoscopic cholecystectomy in terms of operative time and overnight hospital stay.

Methods: This study was done in Surgical Unit IV, SIMS / Services Hospital, Lahore in 6 months [June 20, 2018 till December 20, 2018]. This was a Randomized control trial in which two groups were made randomly using lottery method. In Fundus-First Laparoscopic Cholecystectomy (FFLC) group after insertion of the standard 4 ports, the gallbladder was retracted at the fundus and dissected from the liver fossa to create a space to insert the triangle liver retractor. In Conventional Lap Chole (CLC) group the gallbladder was dissected at Calot's triangle to divide the cystic duct and artery between clips. The organ was then dissected off the liver bed.

Results: Mean duration of surgery in FFLC group was 46.44±6.71 minutes and in CLC group the mean duration of surgery was 57.61±13.31 minutes. The mean duration of surgery in FFLC group was statistically lower as compared to CLC group, p-value < 0.001. In FFLC group 3(7.3%) cases had overnight stay while in CLC group 15(36.6%) cases had overnight stay, the frequency of overnight stay was statistically lower in the FFLC as compared to CLC group, p-value < 0.05.

Conclusion: Through the findings of this study it is concluded that FFLC reduced surgery time and also frequency of overnight stay and resulted in better patient outcomes. So, this technique shall be adopted in the clinical practice in routine for cases of elective laparoscopic cholecystectomy.

Keywords: Gallstones, Laparoscopic cholecystectomy, Fundus First dissection,