Page 19 - World Journal of Laparoscopic Surgery
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Extracorporeal Knotting vs Clips for Ligating Cystic Duct
               In the present study, majority of the control group patients   references
            where titanium clips were used had complications such as
            adhesions, empyema gallbladder, and obese patients due to which     1.  Singh K, Bhatia A, Singh DP. Extra corporeal knotting with silk versus
                                                                    liga clips for ligating cystic duct in laparoscopic cholecystectomy: a
            dissection of Calot’s triangle became difficult which resulted in   comparative study. Int J Sci Res 2017;6(8). DOI: 10.36106/ijsr.
            complications in those patients.                     2.  Zacks SL, Sandler RS, Rutledge R, et al. A population-based
               In the present study, using clips had some drawbacks with   cohort study comparing laparoscopic cholecystectomy and open
            respect to the intraoperative complications; in seven cases, there   cholecystectomy. Am J Gastroenterol 2002;97(2):334–340. DOI:
            was clip slippage and stone spillage seen during the dissection of   10.1111/j.1572-0241.2002.05466.x.
            gallbladder from the liver bed and during extraction. Finding and     3.  Soper NJ, Hunter JG. Suturing and knot tying in laparoscopy. Surg
            retrieving the spilled stones in the peritoneum were again a difficult   Clin N A 1992. DOI: 10.1016/S0039-6109(16)45837-8.
            task which extended the operating time.              4.  Sangwan MK, Vijayata S, Mohinder GK, et al. Triple ligation technique
                                                                    of clipless laparoscopic cholecystectomy: a spanner especially
               In three cases, there was clip slippage at the specimen side   for complicated cholecystitis. IJAM 2017;4(5):1358–1363. DOI:
            and bile was spilled into the peritoneal cavity; in all these cases,   10.18203/2349-3933.ijam20174283.
            peritoneal cavity was irrigated with normal saline.    5.  Leo XLJ, Saravanan S, Muthukumar RP, et al. Comparing the efficacy
               In the present study, in one case, there was clip migration seen   of clipping versus suture ligation of the cystic duct in laparoscopic
            during the final inspection, which needed clipping again.  cholecystectomy: a prospective study. Int J Sci Study 2016;4(6):
               There were two patients from the control group in which   130–132. DOI: 10.17354/ijss/2016/500.
            clipping was planned, which had to be converted to extracorporeal     6.  Seenu V, Shridhar D, Bal C, et al. Laparascopic cholecystectomy: cystic
            knotting due to the wider cystic duct.                  duct occlusion with titanium clips or ligature? A prospective randomized
                                                                    study. Trop Gastroenterol 2004;25(4):180–183. PMID: 15912981.
               In the present study, there was no case with cystic duct leak      7.  ElGeidie AA. New technique of clipless laparoscopic cholecystectomy.
            postoperatively in both the groups, i.e., either with extracorporeal   Surg Sci 2012;3(6):310–313. DOI: 10.4236/ss.2012.36061.
            knotting or clipping of cystic duct, which indicates that cystic duct     8.  Chong VH, Chong CF. Biliary complications secondary to post-
            was safely secured in both the groups. Gallbladder wall thickness   cholecystectomy clip migration: a review of 69 cases. J Gastrointest
            was not considered in our study.                        Surg 2010;14(4):688–696. DOI: 10.1007/s11605-009-1131-0.
                                                                 9.  Bali S, Singal R. Laparoscopic suturing versus clip application in
                                                                    cholecystectomy: tips and strategies for improving efficiency and
            conclusIon                                              safety. Acta Gastroenterol Latinoam 2018;48(1):35–40. https://www.
                                                                    cochranelibrary.com/central/doi/10.1002/central/CN-01464863/full.
            In laparoscopic cholecystectomy, extracorporeal knotting has     10.  Nidoni R, Vudachan T, Sasnur P, et al. Predicting difficult
            the advantages over clipping of cystic duct in operative cost and   laparoscopic  cholecystectomy  based  on  clinicoradiological
            lesser intraoperative complications with the only limitation being   assessment. J Clin Diagn Res 2015;9(12):PC09–PC12. DOI: 10.7860/
            operative time.                                         JCDR/2015/15593.6929.











































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