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Fundus first as the standard technique for laparoscopic cholecystectomy
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0001-6897-2058
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 18736Article in journal (Refereed) Published
Abstract [en]

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004-2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95%CI 1.6-259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019. Vol. 9, article id 18736
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Surgery
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URN: urn:nbn:se:umu:diva-167056DOI: 10.1038/s41598-019-55401-6ISI: 000502008800001PubMedID: 31822771OAI: oai:DiVA.org:umu-167056DiVA, id: diva2:1384064
Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2020-01-09Bibliographically approved

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Cengiz, YucelJänes, ArthurIsraelsson, Leif
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