Dome Down Laparoscopic Cholecystectomy: Our Experience and the State of Art

Introduction: Laparoscopic Cholecystectomy is nowadays the gold standard technique for benign gallbladder disease both in elective and emergency surgery. But it is even true that in very acute cholecystitis when the tissues are inflamed and the anatomy can be difficult to recognize, the classic laparoscopic approach can lead to biliary and vascular injuries. Dome down laparoscopic approach can be used to avoid conversion to open surgery and decrease surgical complications. Methods: A retrospective record of all Cholecystectomy carried out in our unit by experienced surgeons from January 2013 to August 2017 was examined. Cases were divided by surgical technique: Classical laparoscopic technique, Open cholecystectomy, Laparoscopic converted to open cholecystectomy, Dome down laparoscopic Cholecystectomy (DDLC). A systematic literature search was performed using PubMedz and Embase databases. The search was limited to studies on humans and to those reported in the English language between January 2009 and December 2016. Results and discussion: 194 cholecystectomy were performed, among these 163 with laparoscopic technique and 3% of all laparoscopic approached cholecystectomy were performed as DDLC. The mean hospital stay was 5 days (2-11). 1 out of 5 patients needed postoperatory ERCP and endobiliary stent was positioned removed in 30 days with no other complications. Other 4 patients were evaluated after 1 week from dismission with no evidence of postoperative complications. Conclusion: Dome down cholecystectomy is a feasible and safe procedure; it avoids biliary and vascular injuries in difficult cholecystectomy. It can still be improved by the combination with ultrasonic devices or with new surgical techniques such as Single-incision Laparoscopic cholecistectomy.