Dome down approach for difficult laparoscopic cholecystectomy

Background: Visualization of anatomical structures during laparoscopic cholecystectomy may be impaired by diffi culties including severe inflammation in Calot’s triangle, a short cystic duct, tenting of the ductal structures, or Mirizzi’s syndrome. Purpose: To evaluate the feasibility, safety, and outcome of dome-down laparoscopic cholecystectomy in difficult cholecystectomy. Patients and methods: A total of 60 patients with difficult laparoscopic cholecystectomy as decided intraoperatively were enrolled. The dome-down technique was used after a trial of the conventional procedure. Results: There were 33 women (55%) and 27 (45%) men. Their age ranged from 18 to 68 years. Preoperative prediction of difficulty of the operation was anticipated in 37 cases (61.7%). The mean operative time was 102.84 (92–150) min. The conversion rate was 8.3%. The mean hospital stay was 2.5 (2–5) days. Conclusion: Dome-down laparoscopic cholecystectomy is a feasible and applicable procedure during diffi cult cholecystectomy, and yet it needs a learning curve for optimum results.