Abstract
There are various techniques which are devised for dealing with the difficult gallbladders but in certain situations these techniques do not work because of dense adhesions at calot,s triangle with distorted biliary and vascular anatomy with complete visual road block, so only viable option in such situation is to convert to open cholecystectomy. This "Inner view Assisted Fundus First Retrograde Dissection" (I. A. F. R. D.) Technique in laproscopic cholecystectomy is basically innovated to avoid conversion to open cholecystectomy in those situations where there is a frozen triangle of calot with no visible way out so that biliary and vascular injuries can be avoided and laproscopic cholecystectomy can be safely performed and all the benefits associated with minimal invasive surgery may be given to the patients. There is a subgroup of patients encountered intraoperatively with unyielding frozen triangle of calot and even if it is converted to open cholecystectomy the result is not better than I. A. F. R. D. Technique because in this there is a magnified view and outer dissection and its extent is guided from inside the lumen of gallbladder and intra-corporeal suturing and knotting is also taken under vision leaving behind no residual stump and thus avoiding the complications associated with residual stump of gallbladder. In this study of 53 patient on the basis of intraoperative findings of frozen calot, s triangle who underwent "Inner view Assistted Fundus First Retrograde Dissection" technique in laproscopic cholecystectomy over a period of 3 year. The 53 patient are operated by this technique. Among these 31 patient are male and 22 female with age group varying from 43-74 year, majority are above 58 year, 23 patient are of low socioecnomic status, rest are middle and lower middle class, 15 patient are of far off areas and 9 patient have history of abdominal surgery (7 lower and 2 upper abd.) All patients are comparable in their demographic data, clinical, laboratory and imaging parameters. All patients are operated by standard four port technique. All are having intraoperative findings of frozen triangle of calot with associated other findings. There is only one conversion to open cholecystectomy due to acute xanthogranulomatous cholecystitis. Operating time ranges from 45-98 minute, return to normal activities within 3-5 day, postoperative hospital stay is 3-5 day. Thirteen patient have postoperative complications including five port site infections due to infected gallbladder retrieval, three patient have postoperative biliary leaks from liver bed and seven patient have mild systemic infection which settled with antibiotics, no patient has bile duct injury or intraabdominal collection. The laproscopic "INNERVIEW ASSISTTED FUNDUS FIRST RETROGRADE DISSECTION TECHNIQUE'' is a very effective, precise and safe technique and a very viable alternative to conversion to open cholecystectomy in case of difficult gallbladder with frozen calot, s triangle with distorted biliary and vascular anatomy.