Antegrade Dissection in Laparoscopic Cholecystectomy

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of gallbladder antegrade dissection (GAD) cholecystectomy to reduce the risk of common biliary duct injuries and to demonstrate that it is an easier and more time-sparing technique than the traditional one. METHODS: The operative procedure performed since 2002 consists of the incision of the visceral peritoneum from the infundibulum away from Calot's triangle along the gall-bladder bed up to the fundus. Then it continues from the fundus up to the infundibulum. This method was used to perform 127 laparoscopic cholecystectomies (LC) (first group). We compared the results of 119 LC (second group) performed from 1998 to 2001 by means of a completely retrograde method. RESULTS: In both groups, there were no major complications; 1 vs 4 conversions (0.8% vs 3.4%), mean operative time 70 minutes vs 90 minutes, residual choledocholithiasis in 2 patients in both groups (1.6% for the first group vs 1.7% for the second group). CONCLUSIONS: GAD for laparoscopic cholecystectomy can reduce the time of surgery and is an easier technique to perform. Therefore, it can be proposed as the standard procedure and not only be used for difficult cholecystectomies.