Background: Modified fundus-down cholecystectomy is a surgical procedure used to treat patients diagnosed with benign gallbladder disease. This technique begins with Calot’s triangle dissection and attempts to identify key structures such as the cystic artery and duct. Subsequently, fundus-down dissection is performed to separate the gallbladder from the cystic plate. The cystic artery and duct are the final structures that are clipped and cut. In this study, the authors discuss the success and complication rates of this treatment based on their 10-year experience at a tertiary hospital in southern Thailand. Objectives: This study aimed to compare the operative outcomes of conventional laparoscopic cholecystectomy (LC) and modified fundus-down techniques regarding postoperative complications and consequences. Methods: A retrospective analysis of single-centre data from 2010 to 2022 was conducted at our hospital. All patients with gallstone disease who underwent conventional LC or modified fundus-down cholecystectomy were included in the study. The primary outcomes of this study were the incidence of major bile duct injury and the need for further intervention or surgical correction. Results: From a total of 1993 patients who were surveyed, 1612 patients underwent conventional LC and 381 underwent laparoscopic modified fundus-down cholecystectomy. In terms of conversion rate, estimated blood loss, length of hospital stay, and complication rate, there were no differences between the conventional LC and the modified fundus-down approach. However, modified fundus-down cholecystectomy reduced the operative time. The authors collected data from each patient’s sign-in to extubation time (P<0.001). The postoperative complications (P=0.120) and conversion rates (P=0.904) were similar. Conclusion: Laparoscopic modified fundus-down cholecystectomy can be performed in simple and complex cases, including cases of severe fibrosis of the hepatocystic triangle. The study showed that this alternative technique could reduce operative time compared to the conventional technique with no difference in complications, especially common bile duct injury, postoperative common bile duct stones, and postoperative pancreatitis.

Background: Laparoscopic cholecystectomy (LC), a common treatment for symptomatic gallstones, has demonstrated safety in low-risk patients. However, existing data are scarce regarding the safety of LC in high-risk patients and the feasibility of early hospital discharge. Materials and methods: This retrospective study included 2296 patients diagnosed with symptomatic gallstones who underwent LC at a tertiary care centre from January 2009 through December 2019. The authors employed propensity score matching to mitigate bias between groups. Statistical significance was set at P less than 0.05. Results: The median age of the patients was 56 years (range 46–67), with a mean BMI of 25.2±4.3 kg/m². Patients were classified as: American Society of Anesthesiologists (ASA) I (19.7%), II (68.3%), III (12.0%), and IV (0%). ASA I–II included low surgical risk patients (88%) and ASA III–IV comprised high-risk patients (12%). The LC-related 30-day reoperative rate was 0.2% and the readmission rate was 0.87%. Nine patients (0.4%) sustained major bile duct injuries, resulting in a conversion rate of 2.4%. The postoperative mortality rate was 0.04%, and the mean hospitalization time was 3.5 days. Patients in the high-risk group with a history of acute cholecystitis exhibited greater estimated blood loss, longer operative times, and were significantly more likely to be in the longer-stay group. Conclusion: These findings suggest that LC can be conducted safely on high-risk patients, and early hospital discharge is achievable. However, specific factors, such as a history of acute cholecystitis, may result in prolonged hospitalization owing to increased blood loss and longer operative times.

Background/Objective: Bariatric surgery is an established treatment for individuals with severe obesity, providing sustained weight loss and improvement in obesity-related comorbidities. However, evidence on long-term outcomes and predictors of metabolic resolution, particularly among Asian populations, remains limited. We aimed to evaluate metabolic outcomes after bariatric surgery and identify predictive factors associated with remission. Methods: We retrospectively reviewed the data of 581 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at a tertiary care center between January 2012 and December 2022. Surgical techniques, postoperative follow-up, and baseline characteristics were recorded. Remission and improvement of metabolic comorbidities were assessed during 1–5 years of follow-up. Predictive factors were analyzed, and remission rates between SG and RYGB were compared using propensity score matching. Results: A total of 154 (26.5%) individuals had type 2 diabetes mellitus (T2DM), 162 (27.8%) hypertension (HT), 173 (29.7%) dyslipidemia (DLP), and 407 (70.0%) metabolic syndrome (MetS). Remission occurred in 79.1% of individuals with T2DM, 36.0% with HT, 33.9% with DLP, and 79.6% with MetS. Predictive factors included T2DM duration < 3 years, younger age for HT and DLP remission, male sex, body mass index < 43 kg/m², and fasting blood glucose level < 126 mg/dL for MetS. RYGB achieved higher remission of DLP than did SG, whereas other outcomes were comparable. Conclusions: Bariatric surgery effectively improves metabolic comorbidities, and several predictive factors influence outcomes. RYGB resulted in superior remission of DLP, while other metabolic outcomes were comparable between the two procedures.