Page 19 - World Journal of Laparoscopic Surgery

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.

World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 17