Ligature Technique: A Safe Outcome in Laparoscopic Cholecystectomy
Aftab Ahmed Soomro, Shiza Jan Morai, Naina Shakeel, Juwereya Memon, Sohail Yuosif, Rajab Gharno
1038
ABSTRACT
Objective: To compare
Extracorporeal Sliding knot (ECK) and clip ligation to ligation of the cystic
duct in laparoscopic cholecystectomy.
Patients
and Methods: This
study was conducted as prospective randomized study in Jeddah National Hospital
in Jeddah Saudi Arabia, in surgical department carried out from June 2018 to
June 2019. In the study 100 patients were selected and divided into two groups,
in which we compared outcomes of patients in whom Cystic Duct Occlusion was
done by clips (Group I n=60) and other group Ligatures endoloop knotting (Group
II n=40). During laparoscopic
cholecystectomy (LC), cystic duct occlusion can be done with titanium clips or
ligature permanently in order to prevent leakage of bile into the
peritoneal cavity.
Results: Average age of the
patients of clipping group was 43.68 years and the average age of the patients
of knot group was 42.64 years, with male to female ration as 1:4.5. 1:2.3 of
clipping and knot group respectively. Regarding operating time from initial
incision to closure of wound is 61 to 65 minutes in clip group and 69 to 70
minutes in knot group. Longer operating times in knot group is due to learning
curve effect for most surgeons as is evident from the fact that first twenty
surgeries took longer time as compared to subsequent surgeries. The port site
infection was in 03 cases of the clip group 01 in the knot group, drain was
kept in 12 cases in knot group and 06 in clip group, bile leak requiring ERCP
02 cases in clip group and 01 in knot group, retained CBD Stones 01 was in clip
group, obstructive Jaundice was seen in one cases of clip group, while no
mortality was seen in both groups. Although the hospital stay after surgery in
clip group was 1-2 days and in knot group also 1-2 days and in ERCP patients’ Hospital
stay was 2 to 3 days.
Conclusion: Cystic duct occlusion
with knots/ligatures is a safe, cost effective, less post operative pain
alternative to clips as various studies showed clips complications. It also
showed less post-operative pain, less bile leak and port site wound infection.
Safety of using knots/ligatures is even better than clips as is evident from
this study comparing these two methods of cystic duct occlusion.
Key words: cholecystectomy, surgical
clips, surgical knots, surgical ligature, cystic duct occlusion, bile leakage
ABSTRACT
Objective: To compare
Extracorporeal Sliding knot (ECK) and clip ligation to ligation of the cystic
duct in laparoscopic cholecystectomy.
Patients
and Methods: This
study was conducted as prospective randomized study in Jeddah National Hospital
in Jeddah Saudi Arabia, in surgical department carried out from June 2018 to
June 2019. In the study 100 patients were selected and divided into two groups,
in which we compared outcomes of patients in whom Cystic Duct Occlusion was
done by clips (Group I n=60) and other group Ligatures endoloop knotting (Group
II n=40). During laparoscopic
cholecystectomy (LC), cystic duct occlusion can be done with titanium clips or
ligature permanently in order to prevent leakage of bile into the
peritoneal cavity.
Results: Average age of the
patients of clipping group was 43.68 years and the average age of the patients
of knot group was 42.64 years, with male to female ration as 1:4.5. 1:2.3 of
clipping and knot group respectively. Regarding operating time from initial
incision to closure of wound is 61 to 65 minutes in clip group and 69 to 70
minutes in knot group. Longer operating times in knot group is due to learning
curve effect for most surgeons as is evident from the fact that first twenty
surgeries took longer time as compared to subsequent surgeries. The port site
infection was in 03 cases of the clip group 01 in the knot group, drain was
kept in 12 cases in knot group and 06 in clip group, bile leak requiring ERCP
02 cases in clip group and 01 in knot group, retained CBD Stones 01 was in clip
group, obstructive Jaundice was seen in one cases of clip group, while no
mortality was seen in both groups. Although the hospital stay after surgery in
clip group was 1-2 days and in knot group also 1-2 days and in ERCP patients’ Hospital
stay was 2 to 3 days.
Conclusion: Cystic duct occlusion
with knots/ligatures is a safe, cost effective, less post operative pain
alternative to clips as various studies showed clips complications. It also
showed less post-operative pain, less bile leak and port site wound infection.
Safety of using knots/ligatures is even better than clips as is evident from
this study comparing these two methods of cystic duct occlusion.
Key words: cholecystectomy, surgical
clips, surgical knots, surgical ligature, cystic duct occlusion, bile leakage