Methods of cystic duct occlusion during laparoscopic cholecystectomy

Gurusamy, Kurinchi Selvan; Bong, Jin Jong; Fusai, Giuseppe; Davidson, Brian R

doi:10.1002/14651858.cd006807

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…The use of a bioabsorbable polymer clip (Laparo clip TM , Covidien Inc) has also been investigated, which may be preferential to avoid potential nidus stone formation in the cystic duct . The best method of cystic duct ligation cannot be discerned from our study or others due to the lack of randomized control trials . Bile peritonitis did develop 6 days postoperative in 1 dog undergoing laparoscopic cholecystectomy but was due to inadvertent hepatic duct trauma rather than suture slippage from the transected cystic duct.…”

Section: Discussionmentioning

confidence: 60%

“…40 The best method of cystic duct ligation cannot be discerned from our study or others due to the lack of randomized control trials. 41 Bile peritonitis did develop 6 days postoperative in 1 dog undergoing laparoscopic cholecystectomy but was due to inadvertent hepatic duct trauma rather than suture slippage from the transected cystic duct. While suture or surgical clips appears appropriate for ligation of the cystic duct during laparoscopic cholecystectomy in dogs, the laparoscopic surgeon should be capable of performing other methods of cystic duct ligation, especially for very dilated cystic ducts.…”

Section: Discussionmentioning

confidence: 95%

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Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs

et al. 2016

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 95%

Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs

et al. 2016

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“…The authors observed that different energy source equipments may be safe for patients to use with a cautious dissection and sealing of the cystic duct in LC (8). Gurusamy KS (9) found that it was necessary to close the cystic duct completely during LC to avoid leak from stump. There was a statistically significant longer operating time (mean difference 12.00 minutes) in the ligature group than in the non-absorbable clips group (9).…”

Section: Resultsmentioning

confidence: 99%

The Safety and Efficacy of Clipless versus Conventional Laparoscopic Cholecystectomy – our Experience in an Indian Rural Center

Singal

Sharma

Zaman

2018

Maedica

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Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. There are lot of advances in closure of cystic duct and artery (clip ligation, suture ligation), but it remains an enigma regarding efficacy, safety and postoperative complications for using non-absorbable suture material or Liga clip for the operating surgeon in laparoscopic cholecystectomy. Objectives: Our study aimed to evaluate the efficacy, safety and complications of non-absorbable sutures ligation versus clips application in laparoscopic cholecystectomy, and to compare the operative time and cost effectiveness of the two surgical approaches in laparoscopic cholecystectomy. Methods: This prospective study was performed between August 2014 and February 2015 in M. M. Institute of Medical Science and Research, in a rural center, Mullana, India. The study included 160 patients who were diagnosed with chronic cholecystitis in a single unit. Subjects were divided into two groups and all cases were operated by a single surgeon. The cystic pedicle was tied with non-absorbable material (silk 2-0) in group A and with Titanium clips using a clip applicator in group B. Results: The application of silk and clips for cystic duct and artery ligation in laparoscopic cholecystectomy can be safely used. The mean time for ligation of cystic duct was 2.50 (SD ±0.25) in group A and 1.50 min (SD ±1.85) in group B, with P<0.001, which was significant. Similarly, the mean time for ligation of cystic artery was 1.50 min (SD±0.20) in group A and 1.36 min (SD ±0.11) in group B, with P>0.001. There were no postoperative complications, such as wound infection or bile leakage, in any of the two methods. The cost of material for silk suture (40-60 Rupees or 0.62-0.92 $) is definitely much lower than that for Liga clips (790-1000 Rupees or 12.28-15.55 $). For the use of clips, a clip applicator is required, but in case of silk ligation no special instrument is required and silk is also easily available. Conclusion: In laparoscopic cholecystectomy, ligation of cystic duct and cystic artery with clips takes less time than by silk suture. We conclude that both ligation techniques can be safely and effectively used. Training for junior surgeons is necessary to avoid potential complications.

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“…There was no significant (p>0.05) difference in the duration of surgery between the two groups (Group A=40.44±4.63 minutes, Group B=43.32±4.44 minutes) in the present study. Gurusamy et al (2010) 13 showed that the operating time was 12 minutes longer in the absorbable suture ligature group than in the group randomised to clip ligation. Duration of suture ligation is dependant on the surgeon's experience and tends to get shorter with practice as was in our case.…”

Section: Majority Of Patients Of Bothmentioning

confidence: 99%

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

Kumar¹,

Seth²,

Sharma³

2020

IJCMR

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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.

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Methods of cystic duct occlusion during laparoscopic cholecystectomy

Cited by 9 publications

References 18 publications

Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs

Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs

The Safety and Efficacy of Clipless versus Conventional Laparoscopic Cholecystectomy – our Experience in an Indian Rural Center

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

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