A NEW TECHNIQUE FOR LAPAROSCOPIC CHOLECYSTECTOMY - RETROGRADE LAPAROSCOPIC CHOLECYSTECTOMY - AN ANALYSIS OF 81 CASES

Background and Study Aims: A new technique of laparoscopic cholecystec tomy is presented here. This new method, retrograde laparoscopic chole cystectomy (RLC) from fundus to cystic duct downward, may have advanta ges when exposure of the cystic duct and the common duct are difficult and therefore hazardous. Patients and Methods: We carried out laparos copic cholecystectomy in 173 patients; RLC was performed in 81, The op erative procedure is as follows: first, the cystic duct and artery are exposed at the junction of the ampulla, The cystic duct is clipped, a nd the artery is divided, Removal of the gallbladder is then started f rom the fundus to cystic duct downward, After the gallbladder has been dissected from the liver bed, the cystic duct is double-clipped and d ivided, This approach provides better visualization of the gallbladder , cystic duct, and common duct, with less chance of common duct injury , due to clear identification of the ductal system, without the need f or intraoperative cholangiography. Results: Eighty-one RLCs were perfo rmed without severe complications, either immediate or late, The mean operating time was 23 minutes shorter in RLC than in the usual laparos copic cholecystectomy, because intraoperative cholangiography was used much less often. Conclusion: RLC appears to be a safe procedure, and does not affect the conventional method.