A systematic review and meta-analysis showed that in patients with difficult cholecystectomy, fundus first laparoscopic cholecystectomy was linked with fewer risk conversion to open surgery, decreased surgery time, reduced risk of bile duct damage, and shorter hospital stay duration than traditional cholecystectomy. Researchers sought to compare the outcomes of traditional cholecystectomy with fundal first cholecystectomy.

Using search phrases like “dome down cholecystectomy”, “retrograde cholecystectomy”, “fundus down cholecystectomy”, “antegrade cholecystectomy”, and “fundus first cholecystectomy", Embase, Cochrane Library, Pubmed, Google Scholar, and Medline databases were searched by 3 reviewers separately for retrospective or prospective papers contrasting the results of conventional laparoscopic cholecystectomy with fundus first laparoscopic cholecystectomy.

Based on predefined criteria, studies were chosen, and extraction of data was done from the trial for meta-analysis. The meta-analysis included 12 studies. Compared to traditional cholecystectomy, fundus first laparoscopic cholecystectomy was related to a shorter length of hospital stay, a decreased risk of bile duct damage, less time spent in surgery, and reduced conversion to open surgery during difficult cholecystectomy. To sum up, fundus first cholecystectomy can be safely used for difficult cholecystectomy.