Page 16 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
A Comparative Study of Extracorporeal Knotting vs Clips for

Ligating Cystic Duct in Laparoscopic Cholecystectomy

1
2
Hebbatam Vishnu Teja , Deepak R Chavan , Girish Kullolli 3
AbstrAct
The aims of present study were as following: To compare extracorporeal knotting vs clips for ligating cystic duct in laparoscopic cholecystectomy
in terms of feasibility operative time (incision to closer) based on types of cholecystitis postoperative pain, operative cost, and associated
morbidities like gallbladder perforation, bile leak, liver bed injury, port site infection, migration of clips, and slipping of knot.
Methodology: All the patients were assigned by randomization into either of two groups: study group—patients in whom extracorporeal
knotting was done for ligation of cystic duct, and control group—patients in whom clips were used for clipping of cystic duct. Period of study
was from November 2018 to June 2020.
Results: This was a case series analysis conducted from November 2018 to June 2020; i.e., for a period of 20 months, 60 cases were subjected
to laparoscopic cholecystectomy. In the control group, 11 patients had intraoperative complications, and no complications in the study group.
In the study group, mean time taken for the operation was 67.37 minutes when compared to control group of 61.83 minutes. The cost of the
suture material used in study group was 302 rupees, and the average cost of the titanium clips used in control group was 500 rupees.
Conclusion: In laparoscopic cholecystectomy, extracorporeal knotting has the advantages over clipping of cystic duct in operative cost and
lesser intraoperative complications with the only limitation being operative time.
Keywords: Clipping, Cystic duct, Extracorporeal knotting, Laparoscopic cholecystectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1494

IntroductIon 1 Department of General Surgery, Rural Development Trust Hospital,
1
Cholecystectomy is the common operation of the biliary system. Bathalapalle, Andhra Pradesh, India
In cholecystectomy, cystic duct is ligated with the sutures or clips. 2 Department of General Surgery, BLDE (Deemed to be University), Shri
The conception of laparoscopy has revolutionized the art of surgery BM Patil Medical College Hospital and Research Centre, Vijayapura,
due to its advantages over open technique. The lately innovated Karnataka, India
laparoscopic cholecystectomy has been drastically refined over the Corresponding Author: Deepak R Chavan, Department of General
years by better exploration of ergonomics, new energy sources, Surgery, BLDE (Deemed to be University), Shri BM Patil Medical College
2
and endo suturing. The conventional four-port access technique Hospital and Research Centre, Vijayapura, Karnataka, India
has been modified to three ports, two ports, and single incision How to cite this article: Teja HV, Chavan DR, Kullolli G. A Comparative
laparoscopic surgery. Cystic duct ligation methods using metallic Study of Extracorporeal Knotting vs Clips for Ligating Cystic Duct in
clips, harmonic scalpel, plasma kinetic, and intracorporeal and Laparoscopic Cholecystectomy. World J Lap Surg 2022;15(1):14–17.
extracorporeal suturing techniques have been tried with gratifying Source of support: Nil
results. 3–8 Open cholecystectomy is replaced by the gold standard
procedure, i.e., laparoscopic cholecystectomy in the treatment of Conflict of interest: None
gallbladder diseases.
Using clips will reduce the intraoperative time which has (incision to closer) based on types of cholecystitis, postoperative
advantage over the extracorporeal knotting, whereas clips have pain, operative cost, and associated morbidities like gallbladder
the drawback of slippage, resulting in leakage or hemorrhage, perforation, bile leak, liver bed injury, port site infection, migration
and there are situations such as wide cystic duct where clipping of clips, and slipping of knot.
is difficult; in such cases, using the extracorporeal knotting for
occluding the cystic duct is best alternative. Extracorporeal knotting methodology
with absorbable suture material is feasible, practical, economic,
and safe as well. This was a case series analysis done in patients who underwent
In 5–10% of the cases, there are chances of conversion to open laparoscopic cholecystectomy in Department of Surgery at a
cholecystectomy from laparoscopic cholecystectomy. tertiary hospital in North Karnataka.
All the patients were grouped into study group and control
group based on computerized random number tables: Study
AIms And objectIve of study group—patients in whom extracorporeal knotting was done for
The aims of present study were as following: To compare ligation of cystic duct. Control group—patients in whom clips were
extracorporeal knotting vs clips for ligating cystic duct in used for clipping of cystic duct. Period of study was from November
laparoscopic cholecystectomy in terms of feasibility, operative time 2018 to June 2020.

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