Background: Laparoscopic cholecystectomy is routinely approached in two ways: the Calot’s first approach (CFA) and the fundus first approach (FFA). CFA is routinely used when the critical view of safety can be established safely, fundus first approach is useful when the anatomy is obscured due to frozen Calot’s.
Methods: This is a prospective record of all laparoscopic cholecystectomies performed in Sunshine Hospitals, from 2019-2020. Intraoperatively, routinely Calot’s first approach was used and resorted to the fundus first method when difficulties were encountered with exposure of Calot’s triangle. Data was analyzed using a student’s t test and Pearson correlation.
Results: Out of the 151 patients, 64 patients (44%) underwent fundus first and 87 patients (56%) had Calot’s first approach. Mean operative time for FFA (60.23mts ± 25) was similar to CFA (57.18mts ± 25) (P-Value-0.9). Bleeding during surgery was more for FFA (9%) than CFA (7%), though not statistically significant. There were no bile duct injuries, bowel injuries, or conversions. The mean hospital stay was 1.2 days (1-4 days) for FFA and 1.3 days (1-4 days) for CFA. Though, post-operative complications were more with FFA than CFA, [minor bile duct leak (CFA-2% vs FFA-4%), intra-abdominal collection (CFA-3% vs FFA-4%)] the difference was not statistically significant.
Conclusion: Calot’s first method is a useful approach in elective cases, with well-defined anatomy, but it is difficult in cases with severe inflammation in Calot’s, or adhesions leading to frozen anatomy. Fundus first approach was extremely useful in these conditions and could avoid subtotal cholecystectomies, cholecystostomies, and open conversion without bile duct injuries.