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The Surgical outcomes of fundus-first technique in lowering the rate of bile duct injuries and bleeding during open cholecystectomy that facing intraoperative difficulties: A single-center prospective study: The surgical outcomes of open fundus-first cholecystectomy technique.
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Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero. 

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

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Publication Date
Mon Jun 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
Display, analyze and evaluate the alternatives selected models used in the measurement and disclosure of corporate social responsibility
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Thu Dec 20 2007
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Journal Of Planner And Development
Globalization and the identity of the mental image structure of urban spaces
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Publication Date
Fri Jan 01 2016
Journal Name
International Journal Of Advanced Research
ON STABILITY AND THE BOUNDEDNESS OF THE ZERO SOLUTION OF FIFTH ORDER
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Tue Jan 28 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
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Publication Date
Thu Sep 01 2011
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The impact of market orientation and the commitment of employees to performance
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Publication Date
Mon Apr 01 2019
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Journal Of Engineering
The Influence of the Preparation and Stability of Nanofluids for Heat Transfer
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Thu Dec 26 2019
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Publication Date
Wed Mar 29 2017
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Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Improving an Ovulation Rate in Women with Polycystic Ovary Syndrome by Using Silymarin
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Evaluating AI Language Models in News Retrieval: A Comparative Study Of ChatGPT-Plus and DeepSeek (R1)
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