Safe use of vascular stapling devices during laparoscopic cholecystectomy in cases with enlarged cystic canal

Abstract

Objectives: Bile duct injuries and fistulas due to bile leakage are observed at certain rates in laparoscopic cholecystectomy. In complicated cases, in patients with cholelithiasis cystic duct edema, the cystic canal may be enlarged to the extent that it cannot be closed with a clip in a standard operation. In this study we evaluated the eficiency of stapler closure of cystic canal.

Methods: In this retrospective study the cases who had laparoscopic cholecystectomy and cystic canal was closed with stapler between August 2016 and December 2018 were reviewed. Patients' hospital stay and complications were noted.

Results: Thirty-three patients who were electively operated and cystic canal closure was performed with vascular staples because of a wide cystic canal during the operation were included in this study. Low bile drainage was observed in only one case and this patient had spontaneous regression with conservative follow-up. Mean duration of hospital stay was 3.7 days. Patients were followed up from 2 months to 28 months postoperatively.

Conclusions: Endo-vasculer stapler can be used safely during laparoscopic cholecystectomy with a history of stones in the main bile duct. In this group of patients, it is advisable to make preparations in this direction before the operation. 

Keywords

• Wide cystic
• endostapler
• laparoscopic cholecystectomy
• cholelithiasis

References

1. 1. NIH Consensus Conference. Gallstones and laparoscopiccholecystectomy. JAMA 1993;269:1018-24.
2. 2. Muroni M, Loi V, Lionnet F, Girot R, Houry S. Prophylactic laparoscopic cholecystectomy in adult sickle cell disease patients with cholelithiasis: a prospective cohort study. Int J Surg. 2015;22:62-6.
3. 3. Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri VO, Wang DQ. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol 2016;10:93-112.
4. 4. Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A. Laparoscopic subtotal cholecystectomy: a reviewof 56 procedures. J Laparoendosc Adv Surg Tech A 2000;10:31-4.
5. 5. Cushieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161:385-7.
6. 6. Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acutecholecystitis: what is the optimal time for operation? Arch Surg1996;131:540-5.
7. 7. Rattner DW, Ferguson C, Warshaw AL. Factors associatedwith successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993;217:233-6.
8. 8. Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW.Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 2000;66:896-900.

9. 9. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, et al. Randomized trial of early versus delayed laparoscopiccholecystectomy for acute cholecystitis. Br J Surg 1998;85:764-7.
10. 10. Lo CM, Liu CL, Lai EC, Fan ST, Wong J. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1996;223:37-42.
11. 11. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 1997;21:540-5.
12. 12. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early vs delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 2004;18:1323-7.
13. 13. Odabasi M, Muftuoglu MAT, Ozkan E, Eris C, Yildiz MK, Gunay E, et al. Use of stapling devices for safe cholecystectomy in acute cholecystitis. Int Surg 2014;99:571-6.
14. 14. Brooks DC, Becker JM, Connors PJ, Carr-Locke DL. Managementof bile leaks following laparoscopic cholecystectomy. Surg Endosc 1993;7:292-5.
15. 15. Arnaud JP, Bergamaschi R. Migration and slipping of metalclips after celioscopic cholecystectomy. Surg Laprosc Endosc 1993;3:487-8.
16. 16. Mansvelt B, Harb J, Farkas B, Mourou M, Huguet C.‘‘Clipstone’’ filiation within the biliary tract. HPB Surg 1993;6:185-8.
17. 17. Belgaumkar AP, Carswell KA, Chang A, Patel AG. The dangers of using stapling devices for cystic duct closure inlaparoscopic cholecystectomy. Surg Laparosc Endosc PercutanTech 2009;19:194-7.
18. 18. Yeh CN, Jan YY, Liu NJ, Yeh TS, Chen MF. Endo-GIA forligation of dilated cystic duct during laparoscopic cholecystectomy:an alternative, novel, and easy method. J Laparoendosc Adv Surg Technol 2004;14:153-7.
19. 23. Di Lascia A, Tartaglia N, Fersini A, Petruzzelli F, Ambrosi A. Endoscopy for treating minor post-cholecystectomy biliary fistula. A review of the literature. Ann Ital Chir 2018;89:270-7.
20. 24. Mesquita ARM, Iglesias AC. Risk factors for elective laparoscopic cholecystectomy morbimortality in elderly. Rev Col Bras Cir 2018;45:e1995.
21. 19. Ai XM, Ho LC, Yang NY, Han LL, Lu JJ, Yue X. A comparative study of ultrasonic scalpel (US) versus conventional metal clips for closure of the cystic duct in laparoscopic cholecystectomy (LC): a meta-analysis. Medicine (Baltimore) 2018;97:e13735.
22. 20. Nowzaradan Y, Meador J, Westmoreland J. Laparoscopic management of enlarged cystic duct. Surg Laparosc Endosc 1992;2:323-6.
23. 21. Lee MR, Chun HT, Roh YH, Kim SH, Kim YH, Cho SH, et al. Application of an Endo-GIA for ligation of the cystic duct during difficult laparoscopic cholecystectomy. Hepatogastroenterology 2011;58:285-9.
24. 22. Bray F, Balcaen T, Baro E, Gandon A, Ficheur G, Chazard E. Increased incidence of cholecystectomy related to gallbladder disease in France: analysis of 807,307 cholecystectomy procedures over a period of seven years. J Visc Surg 2019;156:209-15.