Clipless Laparoscopic Cholecystectomy: An initial experience of 50 cases in Bangladesh

Pk, Srivastava; Roy, Ratna Rani; Rahman, Mohammad Masudur; Khan, Emrul Hasan; Reza, Syed Masud; Rabbani, Md. Golam; Alom, Kazi Shafiqul

doi:10.3329/jsf.v13i1.27828

Cited by 5 publications

(6 citation statements)

References 12 publications

(9 reference statements)

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“…18 Because of short area of thermal injury this can be used near vital structures; like common bile duct (CBD). Most of our patients were females (71.92%) which were similar to other studies like Saha et al 19 Harmonic scalpel reduces the duration of dissection, with little amount of mist, owing to no wastage of time in smoke evacuation and in changing of instruments. In our study the mean operative time was 24.2 minutes which was comparable to the study done by Jahangir Sarwar Khan et al 20 and Ramos et al 21 There was no bile leak from the cystic duct in our study, there was a single bile leak (0.8%) from duct of lushka which is in accordance with the other studies like Huscher et al 2 , Gelmini et al 22 , Bessa et al 23 , El nakeeb et al 24 In our case the patient was managed conservatively by ERCP and with sphinterotomy.…”

Section: Discussionsupporting

confidence: 90%

Clipless Laparoscopic Cholecystectomy: Our Experience

Attri¹,

Kumar²,

Mir³

et al. 2019

IJCMR

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Background:Laparoscopic cholecystectomy (LC) is accepted as the gold standart treatment of gallstones. Various methods have been developed to close the cystic duct (CD) and cystic artery (CA), but titanium clip application is currently the most frequently used technique. High-tech electrosurgical instruments, such as Harmonic Scalpel (HS), have been used both for dissection of the cystic artery and Cystic duct. The present study was conducted to observe and establish efficacy of clipless cholecystectomy, by use of harmonic scalpel as an alternative, for division and sealing of cystic artery and cystic duct. Methods:This study was a hospital based, retrospective study, conducted in Govt. Medical College, Srinagar, using medical records. A total of 114 patients included in the study, having been operated by a single surgeon over time period of 5 years from February 2014 to january 2019. Results:In our study of 114 patients 82 (71.92%) were females and 32 (28.07%) were males with average age of 41.4years (16-72 yr). No patient was converted to open with average operating time of 24.2 minutes (18-46 minutes). Mean hospital study was 1.42 days (1-8 days) with no mortality. Postoperative complications were found in 6 (5.2%) patients with bile leak from duct of Lushka in 1 (0.8%) patient, port site infection in 2 (1.7%) patients and fever in 3 (2.6%) patients.Gallbladder perforation intraoperatively was seen in 7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent option for the cystic duct closure with less time consumption and less complications.

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Section: Discussionsupporting

confidence: 90%

Clipless Laparoscopic Cholecystectomy: Our Experience

Attri¹,

Kumar²,

Mir³

et al. 2019

IJCMR

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“…Similar results were reported by PK Saha, Ratna Rani Roy et al in a study conducted in Bangladesh in which it was concluded that Clipless LC is a safe and effective method with no bile leak or other complications related to ligature. 14 Similarly, in another study it has been reported that the incidence of biliary leakage was statistically significantly higher in the clipped group, compared to the clipless group (30 vs. 10%, respectively; P=0.002) with a lesser median operative time in the HS group than in the Clips group (32 vs. 40 minutes, respectively; P=0.000). 6 A study by Tharwat Kandil et al concluded that clipless surgery is an effective and safe method for hemobiliary with less operative time along with decreased risk of biliary leakage and the further complications and management related with gall bladder perforation.…”

Section: Discussionmentioning

confidence: 78%

Clipped or Clipless Cholecystectomy

Akhtar¹,

Farooq

Rathore

et al. 2018

TPMJ

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Background: Cholecystectomy is the surgical removal of the inflamedgallbladder. Advancement in technology has led to many treatment options and methods ofcholecystectomy but the selection of right method depends upon severity of disease alongwith available resources and expertise. Objective: To compare the frequency of biliary leakagewith clipless versus clipped laparoscopic cholecystectomy for management of cholecystitis.Material & Methods: Study design: Randomized control trial. Setting: Unit 1, Departmentof Surgery, Jinnah hospital, Lahore. Duration: It was conducted for a period of six monthsfrom July 2016 to January 2017. Data collection: A total of 130 patients were included in thestudy using nonprobability consecutive sampling and were randomly divided in two groups byusing lottery method. In group A, clip-less Harmonic scalpel was used along with Ultrasonicshear. In group B, the conventional instruments were used with the application of clips. Patientswere called for follow-up in OPD after 1 week to assess biliary leakage through MRCP. All thedata was collected through a pre-designed proforma. The data was entered and analyzed inSPSS version 20. Results: The mean age of patients was 42.97±10.77 years with 68 (52.31%)patients were male and 62 (47.69%) patients were females. The biliary leakage was noted in29 cases i.e. 9 from clipless group and 20 were from clipped group and the difference wasstatistically significant (p-value=0.020) Conclusion: It can be concluded from this study thatthe frequency of biliary leakage is significantly higher in the clipped LC for management ofCholecystitis. Thus it is encouraging to use clipless method to avoid such complication andimprove surgical outcomes.

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“…10 Saha et al conducted a study in Bangladesh and reported that the clipless cholecystectomy is an effective and safe method for removing gall bladder as it is associated with less incidence of gall bladder perforation and biliary leakage. 15 Another study conducted by Gelmini et al showed that mean operative time was significantly shorter in the group operated upon by the harmonic scalpel. 16 The biggest hurdle in the way of using harmonic scalpel is the requirement of expertise and expensive instruments, which are difficult to procure in a developing country like Pakistan.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan

Manan

Khan²,

Ahmad

et al. 2020

J Islamabad Med Dental Coll

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Objective: To compare the efficacy of clipless cholecystectomy using harmonic scalpel and clipped conventional laparoscopic cholecystectomy. Study design: A randomized control trial. Place and duration of study: Department of general surgery at Nishtar Hospital Multan, from October 1st 2019 to March 31st 2020. Methodology: Total 188 patients of gallstone related cholecystitis were enrolled in the study and were selected using non-probability consecutive sampling technique. All the patients were randomly divided into two equal groups. One group was designated for clipless and the other for conventional clipped laparoscopic cholecystectomy. Age, gender, duration of cholecystitis, duration of Procedure, hospital stay, usefulness in difficult procedures and biliary leakage were recorded for all the patients. Data was entered in SPSS version 23 and analyzed. Results: Operation time was 28.35±7.92 minutes and 21.15±4.47 minutes in clipped and unclipped surgery, respectively (p<0.001). Hospital stay was 2.37±0.60 days in clipped surgery group and 1.71±0.74 days in clipless surgery group (p<0.001). Biliary leakage was reported in 2(2.1 %) patients of the clipped group and 1(1.1%) patients of the unclipped group (p = 0.561). Usefulness of the procedure in difficult cases was documented in 0 (0.0%) of the clipped procedures and in 8 (8.5%) of the clipless procedures (p=0.004). Conclusion: As witnessed from this study, it can be concluded that clipless surgery is a better option as compared to the clipped conventional laparoscopic Cholecystectomy as former is associated with shorter operation time, shorter hospital stay and better usefulness in difficult cases.

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Clipless Laparoscopic Cholecystectomy: An initial experience of 50 cases in Bangladesh

Cited by 5 publications

References 12 publications

Clipless Laparoscopic Cholecystectomy: Our Experience

Clipless Laparoscopic Cholecystectomy: Our Experience

Clipped or Clipless Cholecystectomy

Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan

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