Laparoscopic Cholecystectomy Without Clips : Our Experience at a Teaching Hospital in Eastern India.

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D. J. . Kumar, D. D. . Prasad, D. A. . Atreya, and D. H. Kumar, “ Laparoscopic Cholecystectomy Without Clips : Our Experience at a Teaching Hospital in Eastern India”., ijmhs, vol. 11, no. 01 (Jan- Feb), pp. 1520–1526, Jan. 2021.
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Abstract

Introduction:-In laparoscopic cholecystectomy (LC) ,the gold standard for gallstone disease , cystic duct and artery are conventionaly secured with titanium clips. Intracorporeal knotting and  ligation is thought to be  superior to extra corporeal knotting22. Most of the laparoscopic surgeons using knotting for securing cystic duct and cystic artery perform separate individual  ligations of duct and artery.This is  technically demanding and time consuming. On the other hand  harmonic scalpel and ‘LigaSure’ are expensive and hence prohibitory for resource limited country like India16,18. Methods:-We performed intracorporeal “single ligation of cystic artery and duct” with free silk sutures. From January 2016 to December  2018, we employed successfully performed  single ligation of cystic artery and duct (SLAD) with silk 1/0 in symptomatic cholelithiasis patients undergoing LC.The various parameters of SLAD were compared with another group of 100 cases of LC in which duct and artery were ligated individually. Out of 108 cases  included in this study undergoing elective laparoscopic cholecystectomy 80 (74.1%) were females16 .Average age of patients was 36 yr (12- 65yrs). We had bile leak in 2 cases and no other complications related to ligature. The average time taken for knotting was 7 minutes (varied from 3 to 11 minutes). In 7 cases, 5th port was needed  to grasp and secure the bleeding vessels. There were 12 (11.1%) acute calculus cholecystitis, 6(5.5%) mucocele,2(1.8%) empyema.We had no  gangrenous cholecystitis. Bile leak was encountered I 2 cases in both groups ,3 patients (2.7%) had inflammation of umbilical port which  healed in due course of convalescence3,5,7,8. All these parameters were compared with another group of LC with individual ligation of ducts and artery in tabulated form and overall results were similar. Conclusion:- intracorporeal single ligation of cystic artery and duct (SLAD) in LC is simple, safe and economical and can easily be practised. SLAD marginally  increases operative time that improves with practice as only single tie is used. Thus  no clip laparoscopic cholecystectomy (NCLC)by either method of ligation  eliminates the clip related complications of LC6,9,10.

 

Keywords: Clips, cystic duct, laparoscopic cholecystectomy, ligation.

Abbreviations; LC=Laparoscopic Cholecystectomy; GB=Gallblagger; SLAD=Single ligation of cystic artery and duct.NCLC= No clip laparoscopic cholecystectomy,NOTES= Natural orifice transluminal endoscopic surgery

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