Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety
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| Natura: | Artículo científico |
| Lingua: | en |
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Sociedad Argentina de Gastroenterología
2018
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| _version_ | 1876483890874417152 |
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| author | Bali Sharadendu |
| author_facet | Bali Sharadendu |
| contents | Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety Bali Sharadendu Singal Rikki Medicina clips complications cystic duct leaks intracorporeal ligation Laparoscopic cholecystectomy Even though laparoscopic cholecystectomy emerged over 20 years ago, controversies persist with regards to the best method to ligate the cystic duct and artery. We proposed to assess the safety, cost effectiveness and feasibility of different methods to close the cystic duct and artery by suture ligation versus clip application working in rural area where latest facilities are limited. Even today the latest Harmonic Scalpel and Plasma Kinetic have become popular with the promise of quick and effective vascular control, but again these are less cost-effective and problem of availability in rural area still exists. Aim. Evaluate the effectiveness in terms of cost, safety and complications in ligation of the cystic artery and duct separately with non-absorbable suture ligation compared to clip application. Our aim is for surgeons sitting in rural area, where latest facilities are not available, they can ligate the CD or artery using non-absorbable suture which is cheaper and cost-effective without encountering any bile leakage or bleeding. Silk suture can be tied near to the CBD as risk of involving the CBD wall is less as compared to clips. Settings and design. A prospective randomised double blind study. Material and methods. This was a randomised controlled prospective study carried out at a medical college hospital (in remote village) from period of January 2011 to February 2012 in India. A total number of 160 cases were selected in the study, out of which 40 cases were excluded as per the selection criteria. Patients were selected randomly and divided into two groups diagnosed as chronic cholecystitis (cholelithiasis). In group A (study group-60 cases) cystic pedicle was ligated by silk sutures 2-0 (intracorporeal knots) while in group B (control group-60 cases) cystic pedicle was closed with titanium clips using a clip applicator. Results. Out of total 120 patients, in group A (60 patients), cystic duct and artery were ligated separately using silk suture and in group B (60 patients) the pedicle was closed using titanium clips. The operative time in group A was 30 to 50 mins and in group B it was 30 to 40 minutes (p = 0.015). The time required for suture ligation was 6.5 ± 1.3 mins and for ligaclips it was only 4 ± 1.1mins thus decreasing the overall operative time of the procedure (p > 0.001). Drainage was required in 45 patients in A and in 40 patients in group B. It was removed on 2nd of surgery according to the colour and volume. Overall cost of procedure was more in group B as compared to group A. There was no statistically significant difference found between the two groups in terms of length of inpatient stay, post-operative complications and safety of procedure. However, the mean operative time was lesser in whom cystic artery and duct were clipped than suture ligation. Conclusion. The ligation with suture needs more expertise than clip which is easy for trainees. It is difficult where latest and well equipped centres are there for cyst 2018 artículo científico 2469-1119 https://www.redalyc.org/articulo.oa?id=199355697014 https://www.redalyc.org/journal/1993/199355697014/ https://www.redalyc.org/journal/1993/199355697014/html/ https://www.redalyc.org/journal/1993/199355697014/199355697014.epub https://www.redalyc.org/journal/1993/199355697014/movil en http://www.redalyc.org/revista.oa?id=1993 Acta Gastroenterológica Latinoamericana application/pdf Sociedad Argentina de Gastroenterología Acta Gastroenterológica Latinoamericana (Argentina) Num.1 Vol.48 |
| format | Artículo científico |
| id | redalyc_199355697014 |
| institution | Redalyc |
| language | en |
| publishDate | 2018 |
| publisher | Sociedad Argentina de Gastroenterología |
| spellingShingle | Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety Bali Sharadendu Medicina clips complications cystic duct leaks intracorporeal ligation Laparoscopic cholecystectomy Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety Bali Sharadendu Singal Rikki Medicina clips complications cystic duct leaks intracorporeal ligation Laparoscopic cholecystectomy Even though laparoscopic cholecystectomy emerged over 20 years ago, controversies persist with regards to the best method to ligate the cystic duct and artery. We proposed to assess the safety, cost effectiveness and feasibility of different methods to close the cystic duct and artery by suture ligation versus clip application working in rural area where latest facilities are limited. Even today the latest Harmonic Scalpel and Plasma Kinetic have become popular with the promise of quick and effective vascular control, but again these are less cost-effective and problem of availability in rural area still exists. Aim. Evaluate the effectiveness in terms of cost, safety and complications in ligation of the cystic artery and duct separately with non-absorbable suture ligation compared to clip application. Our aim is for surgeons sitting in rural area, where latest facilities are not available, they can ligate the CD or artery using non-absorbable suture which is cheaper and cost-effective without encountering any bile leakage or bleeding. Silk suture can be tied near to the CBD as risk of involving the CBD wall is less as compared to clips. Settings and design. A prospective randomised double blind study. Material and methods. This was a randomised controlled prospective study carried out at a medical college hospital (in remote village) from period of January 2011 to February 2012 in India. A total number of 160 cases were selected in the study, out of which 40 cases were excluded as per the selection criteria. Patients were selected randomly and divided into two groups diagnosed as chronic cholecystitis (cholelithiasis). In group A (study group-60 cases) cystic pedicle was ligated by silk sutures 2-0 (intracorporeal knots) while in group B (control group-60 cases) cystic pedicle was closed with titanium clips using a clip applicator. Results. Out of total 120 patients, in group A (60 patients), cystic duct and artery were ligated separately using silk suture and in group B (60 patients) the pedicle was closed using titanium clips. The operative time in group A was 30 to 50 mins and in group B it was 30 to 40 minutes (p = 0.015). The time required for suture ligation was 6.5 ± 1.3 mins and for ligaclips it was only 4 ± 1.1mins thus decreasing the overall operative time of the procedure (p > 0.001). Drainage was required in 45 patients in A and in 40 patients in group B. It was removed on 2nd of surgery according to the colour and volume. Overall cost of procedure was more in group B as compared to group A. There was no statistically significant difference found between the two groups in terms of length of inpatient stay, post-operative complications and safety of procedure. However, the mean operative time was lesser in whom cystic artery and duct were clipped than suture ligation. Conclusion. The ligation with suture needs more expertise than clip which is easy for trainees. It is difficult where latest and well equipped centres are there for cyst 2018 artículo científico 2469-1119 https://www.redalyc.org/articulo.oa?id=199355697014 https://www.redalyc.org/journal/1993/199355697014/ https://www.redalyc.org/journal/1993/199355697014/html/ https://www.redalyc.org/journal/1993/199355697014/199355697014.epub https://www.redalyc.org/journal/1993/199355697014/movil en http://www.redalyc.org/revista.oa?id=1993 Acta Gastroenterológica Latinoamericana application/pdf Sociedad Argentina de Gastroenterología Acta Gastroenterológica Latinoamericana (Argentina) Num.1 Vol.48 |
| title | Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety |
| topic | Medicina clips complications cystic duct leaks intracorporeal ligation Laparoscopic cholecystectomy |
| url | https://www.redalyc.org/articulo.oa?id=199355697014 https://www.redalyc.org/journal/1993/199355697014/ https://www.redalyc.org/journal/1993/199355697014/html/ https://www.redalyc.org/journal/1993/199355697014/199355697014.epub https://www.redalyc.org/journal/1993/199355697014/movil |