Laparoscopic cholecystectomy from fundus downward.

Laparoscopic cholecystectomy from fundus downward (LCFD) is desirable when exposure of the cystic duct is difficult and hazardous. First the cystic duct and artery are exposed and clipped, and the artery is divided. Then removal of the gallbladder is started from fundus downward. After the gallbladder is dissected from the liver bed, the cystic duct is double clipped and divided. This approach affords better visualization of the cystic duct and common duct with less chance of common duct injury. Twenty-eight LCFDs were performed without complications, immediate or late. LCFD appears to be a safe procedure and does not compromise the retrograde method.