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