SP6.1.8Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review

Abstract Aims Retrograde ‘fundus-first’ cholecystectomy is when the dissection starts from fundus of gallbladder to infundibulum, in case structures Calot's triangle cannot be identified. Although feasible laparoscopic cholecystectomy, it remains an underutilized approach. We aimed systematically review fundus-first and study its safety feasibility. Methods A systematic was performed compliance with PRISMA guidelines. literature search using PubMed/MEDLINE, ScienceDirect Cochrane-Library for articles published 2010 2020. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ ‘fundus-down cholecystectomy’. Quality assessments were applied Medical Education Research Instrument (MERSQI) score. The protocol registered PROSPERO register. Results total 3503 studies formed base evidence evaluations. 12 1978 cholecystectomies assessed. Three citations scored high 5 moderate quality. Endpoints blood loss, rate conversion open, bile duct injury, gallbladders perforations, postoperative pain hospital stay. Nine provided both strong scientific a positive outcome Conclusion associated reduced need intraoperative cholangiography, shorter operating time, lower incidence intra-operative complications, injury open cholecystectomy.