Résumé
Fundus first laparoscopic cholecystectomy is becoming an option with experienced laparoscopic surgeons to deal with difficult anatomy at Calot's triangle and thereby reducing the conversion rate and rate of complications. Fundus first laparoscopic cholecystectomy was done in 40 patients between three year. There were 26 female & 14 male patients with mean age of 36 years (range 29-64). Reasons for opting for fundus first method were: dense adhesions at Calot's trianglein 26 patients, stones in Hartmann's pouch with short cystic duct 8 , small contracted gall bladder in 4 and Mirizzi's syndrome in 2 patients. Mean operating time was 96 minutes (range 80-135 mts). 3 Patients were converted to open cholecystectomy because of obscure anatomy, intraoperative hemorrhage and CBD injury. The Patient with CBD injury was managed by hepaticojejunostomy. 5 Patients developed postoperative biliary fistula and one Patient had prolonged ileus. Out of the 5 Patients 2 were managed with percutaneous drainage and the biliary leak stopped and 3 Patients required ERCP and stenting. The Patient with ileus was managed conservatively and was discharged on the 6th day. The average hospital stay was 4 days. Fundus first laparoscopic cholecystectomy offers the surgeon the same safety and versatility during laparoscopic cholecystectomy that it confers during open cholecystectomy. It is a viable and a safe option in the hands of an experienced laparoscopic surgeon and it helps in reducing the conversion rate and may also decrease the risk of injury to biliary system.