Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

Abstract

Introduction: Laparoscopic cholecystectomy today has been rapidly embraced worldwide as the procedure of choice for cholecystectomy. Conventionally, titanium clips are used to ligate the cystic duct. Recently, various methods of suture ligation of the cystic duct both intra corporeal and extra corporeal have been described during laparoscopic cholecystectomy. Only limited number of studies have been carried out prospectively to compare the various methods. The present study was thus designed to compare clip occlusion versus extra corporeal suture ligation (Roeder knot) of the cystic duct in laparoscopic cholecystectomy. Material and methods: This study was a single blinded randomized controlled trial conducted on 150 adult patients undergoing laparoscopic cholecystectomy. They were randomized into two groups of 75 each to compare the procedures of clip occlusion versus extracorporeal suture ligation (Roeder knot) of the cystic duct with respect to the operative time, complications, associated morbidity, operative cost and hospital stay. Results: There was no significant (p>0.05) difference in duration of surgery between the groups (Clip ligation=40.44±4.63 minutes, suture ligation=43.32±4.44 minutes). Bile leakage due to slippage of ligature was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was found to be statistically significant (p=0.03). Obstructive jaundice due to accidental ligation of CBD was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was also found to be statistically significant. (p=0.03). The cost of Clip ligation (Rs.369.07±8.08) was higher than suture ligation (Rs.300.00±0.00). Conclusion: The results of this study indicate that extracorporeal (Roeder's knot) is a safe, cost effective alternative with a low complication rate as compared to titanium clip ligation of the cystic duct in laparoscopic cholecystectomy.

Evaluation of Clipless Laparoscopic Cholecystectomy with the Aid of Extracorporeal Mishra’s Knot

“…The mean time taken to complete the entire procedure was 61.81 minutes ±3.31 that was much longer than the time taken by Kumar et al 6 as their time of laparoscopic cholecystectomy by using knotting was 43.32 ± 4.44 minutes. Different suturing skills and unsimiliar learning curve could be the justification.…”

“…Many alternatives to titanium clips such as different types of intracorporeal or extracorporeal suturing techniques or recently ultrasonic dissectors have been used for cystic duct occlusion. 6 Few studies have evaluated the use of extracorporeal knotting in terms of safety, cost effectiveness and postoperative complications thus generating this study.…”