Closure of the Cystic Duct Comparison Ultrasonic Harmonic Scalpel versus Clip Application in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is usually performed using titanium clips (TC) for occlusion of the cystic duct and cystic artery. The use of Harmonic scalpel (HS) in LC has been reported. Aim: This study aimed to compare effect of HS and clips application for closure of the cystic duct and artery in patients undergoing LC. Patients and Methods: Totally 50 patients were operated using LC technique from April 2010 to April 2012. Patients were retrospectively, divided into 2 groups according to the instruments used for division of the cystic artery and duct as well as for dissection of the liver bed. On the one hand, group 1 consisted of 30 patients who were all treated with the ultrasonic harmonic scalpel as the sole instrument used in the whole procedure. On the other hand, group 2 comprised 20 patients in whom dissection and coagulation were performed using monopolar coagulation, and occlusion of the artery and duct with clips. The operative time, postoperative hospital stay, morbidity, and mortality for each group were analyzed and compared with each other. Results: The 2 groups were comparable for age, sex, indication for cholecystectomy, and combined procedures. Patients were randomly treated either with the ultrasonic HS or with clips. Postoperative hospital stay of all patients in the group 1 and group2 was 2 days. Superficial wound infection seen in one patient (2%) in group 2 which was treated by oral antibiotics. During the follow-up period, one port-site hernia was detected in one patient (2%) in group 2. One case (2%) of peritoneal fluid collection seen in (group 1) and treated with percutaneous drainage was found. Conclusions: The use of harmonic scalpel was accepted as a reasonable alternative for closure of cystic ducts < 4 mm in diameter. This Study has shown that the HS is an effective and safe tool for the closure of both the cystic duct and artery in patients who undergo LC.