Fundus-First Laparoscopic Cholecystectomy in Difficult Gallbladders: A Safe Alternative Technique

NCT07113704 | Completed

• 1 other identifier: FFLC2025AMSUKI
• Study Type: observational
• Target: 124
• Locations: 1 country
• Sites: 1

Brief Summary

This retrospective cross-sectional study evaluated the safety and effectiveness of the fundus-first laparoscopic cholecystectomy (FFLC) technique in patients with difficult gallbladders. A total of 124 patients who underwent FFLC between 2023 and 2024 were reviewed. The study assessed operative time, intraoperative complications, conversion rates, and postoperative outcomes. The results suggest that FFLC is a safe and feasible approach that can reduce the need for conversion to open surgery in complex cases. The study was conducted at a private hospital in Istanbul, Turkey

Conditions

Cholelithiasis

Keywords

fundus-first laparoscopic cholecystectomy; difficult cholecystectomy; Cross-sectional study; General surgery; Laparoscopic cholecystectomy; Tertiary care hospital

Outcome Measures

Primary Outcomes (1)

• Conversion Rate to Open Surgery

  Rate of conversion from laparoscopic to open cholecystectomy in each group. Measured as number and percentage of patients converted.

  Intraoperative (during surgery)

Secondary Outcomes (3)

• Operative Time

  Intraoperative (during surgery)

• Postoperative Complication Rate

  Within 30 days postoperatively

• Length of Hospital Stay

  Postoperative hospitalization

Study Arms (2)

Conventional Laparoscopic Cholecystectomy

Patients who underwent standard laparoscopic cholecystectomy, starting dissection at Calot's triangle. This technique served as the comparator for assessing safety and conversion rates relative to the fundus-first approach.

Procedure: Conventional Laparoscopic Cholecystectomy

Fundus-First Laparoscopic Cholecystectomy

Patients with difficult gallbladders (Nassar Grade 3-4) who underwent laparoscopic cholecystectomy using the fundus-first technique. This approach involved starting dissection at the gallbladder fundus and proceeding retrogradely toward Calot's triangle to improve safety in complex cases.

Procedure: Fundus-First Laparoscopic Cholecystectomy

Interventions

Conventional Laparoscopic Cholecystectomy PROCEDURE

Standard laparoscopic cholecystectomy technique starting at Calot's triangle. Used as the comparator group in this study.

Also known as: Antegrade Laparoscopic Cholecystectomy

Conventional Laparoscopic Cholecystectomy

Fundus-First Laparoscopic Cholecystectomy PROCEDURE

Laparoscopic cholecystectomy technique initiated at the gallbladder fundus and carried out retrogradely toward Calot's triangle. This method was applied to difficult gallbladders (Nassar Grade 3-4) to improve operative safety and avoid conversion to open surgery.

Also known as: Retrograde laparoscopic cholecystectomy

Fundus-First Laparoscopic Cholecystectomy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

This study included adult patients (≥18 years) who underwent laparoscopic cholecystectomy for difficult gallbladder (Nassar grade 3-4) at a single tertiary care center between January 2023 and March 2024.

You may qualify if:

• Patients who underwent laparoscopic cholecystectomy at the study center between January 2023 and March 2024
• Patients diagnosed with difficult gallbladder (Nassar Grade 3-4)
• Age ≥ 18 years
• Complete clinical data available for analysis

You may not qualify if:

• Patients with incomplete medical records
• Patients undergoing open cholecystectomy from the beginning
• Patients under 18 years of age

Sponsors & Collaborators

• KANAN ISMAYILZADA, MD: lead

Study Sites (1)

Medicana Ataşehir International Hospital

Istanbul, Ataşehir, 34750, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Cholelithiasis

Condition Hierarchy (Ancestors)

Biliary Tract Diseases; Digestive System Diseases

Study Officials

• KANAN ISMAYILZADA, MD

  Medicana Ataşehir International Hospital, ISTANBUL.TURKEY

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: General Surgeon

Study Record Dates

• First Submitted: July 25, 2025
• First Posted: August 11, 2025
• Study Start: January 5, 2023
• Primary Completion: April 1, 2024
• Study Completion: April 10, 2024
• Last Updated: August 11, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)