A prospective observational study on cystic stump closure during laparoscopic cholecystectomy: silk sutures (intra-corporeal ligation) or locking clips (Hem-o-Lok®)

Yıl 2022, Cilt: 8 Sayı: 5, 695 - 701, 04.09.2022

Mustafa Yeni Tolga Kalaycı

https://doi.org/10.18621/eurj.1118832

Öz

Objectives: The present study compares the clinicopathological features and outcomes of two cystic stump closure techniques (locking clips and intra-corporeal ligation with silk sutures) during laparoscopic cholecystectomy.

Methods: This study was conducted in a tertiary health centre as a prospective observational study between October 5, 2021, and February 15, 2022. For randomisation, double rows of silk sutures were used to close the cystic stump in patients on the odd-numbered day of the month (Group 1). In contrast, a single-row locking clip (Hem-o-Lok®) (Group 2) was used to close the cystic stump in patients on the even-numbered day of the month. The study was terminated when at least 50 patients were reached in both groups. The clinicopathological differences and cholecystectomy outcomes were compared between the groups.

Results: This observational study included 114 patients. Of the study cohort, 87 (76.3%) were female, and the mean age was 46.54 ± 14.74 years. There were 64 (56.1%) patients in Group 1 and 50 (43.9%) patients in Group 2. Preoperative ERCP requirement was higher in Group 1 (15.6% vs 4%, p = 0.045), while the mean operation room time was longer in Group 2 (p = 0.015). Morbidity rates were similar in the two groups (3.1% vs 2%) (p > 0.05).

Conclusions: Cystic stump closure is the essential step of laparoscopic cholecystectomy. According to the present study’s results, silk sutures (intra-corporeal ligation) and locking clips (Hem-o-Lok®) are materials that can be used safely to close a cystic stump.

Anahtar Kelimeler

Cholecystectomy, clips, cystic duct, laparoscopy, morbidity, suture.

Kaynakça

• 1. Hida Y, Okuyama S, Iizuka M, Katoh H. New technique to ligate enlarged cystic duct using a clip applier during laparoscopy: report of a case. Hepatogastroenterology 2002;49:926-7.
• 2. Abbas I. Overlapped-clipping, a new technique for ligation of a wide cystic duct in laparoscopic cholecystectomy. Hepatogastroenterology 2005;52:1039-41.
• 3. Ahmad F, Saunders R, Lloyd G, Lloyd D, Robertson G. An algorithm for the management of bile leak following laparoscopic cholecystectomy. Ann R Coll Surg Engl 2007;89:51-6.
• 4. Van Dijk AH, van Roessel S, de Reuver PR, Boerma D, Boermeester MA, Donkervoort SC. Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy. World J Gastrointest Surg 2018;10:57-69.
• 5. Duca S, Bala O, Al‐Hajjar N, Iancu C, Puia I, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2003;5:152-8.
• 6. Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost analysis and supply utilization of laparoscopic cholecystectomy. Minim Invasive Surg 2018;2018:7838103.
• 7. Strasberg SM. Tokyo guidelines for the diagnosis of acute cholecystitis. J Am Coll Surg 2018;227:624.
• 8. Hassler KR, Collins JT, Philip K, Jones MW. Laparoscopic cholecystectomy. StatPearls [Internet] 2021. Access Time: April 1, 2022.
• 9. Loozen CS, van Ramshorst B, van Santvoort HC, Boerma D. Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg 2017;34:371-9.
• 10. Singal R, Zaman M, Mittal A, Singal S. The safety and efficacy of clipless versus conventional laparoscopic cholecystectomy–our experience in an Indian rural center. Maedica (Bucur) 2018;13:34-43.
• 11. Seenu V, Shridhar D, Bal C, Parshad R, Kumar A. Laparascopic cholecystectomy: cystic duct occlusion with titanium clips or ligature? A prospective randomized study. Trop Gastroenterol 2004;25:180-3.
• 12. Sharadendu B, Rikki S. Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety. Acta Gastroenterol Latinoam 2018;48:35-40.
• 13. Ismaeil DA, Shkor FN, Salih AM, Ahmed MM, Said AH, Ali HO, et al. Tie versus clipping typed of cystic duct and artery ligation in laparoscopic cholecystectomy. Bali Med J 2020;9:556-61.
• 14. Shah J, Maharjan S. Clipless laparoscopic cholecystectomy-a prospective observational study. Nepal Med Coll J 2010;12:69-71.
• 15. Talebpour M, Panahi M. New aspects in laparoscopic cholecystectomy. J Laparoendosc Adv SurgTech A 2007;17:290-5.