Isolation and Clipping of Cystic Artery outside Versus inside Calot?s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is the “Gold Standard“ for the treatment of cholelithiasis and acute cholecystitis, and is the commonest operation performed laparoscopically worldwide. In spite of this fact , still the most serious complications like extrahepatic bile duct injury (BDI) & vascular injury, are more common in LC than OC(open cholecystectomy).Objectives: to compare between the isolation & clipping of cystic artery outside & inside Calot’s triangle in regard of minimizing the intraoperative complications in LC. Patients and methods: This is a prospective( therapeutic controlled trial ) study of 508 patients with symptomatic gallstones (456/508=90% females & 52/508=10% males) who were admitted to Al-Diwaniya teaching hospital to undergo LC from April 2015 to April 2018.Group–A-: consists of 272 patients (246/272=90.4% F & 26/272=9.6% M) selected to undergo a LC with standard conventional technique of dissection of cystic pedicle. Group –B-: consists of 236 patients (210/236=89% F & 26/236=11% M) selected to undergo LC with isolation & clipping of cystic artery outside the Calot’s triangle. Results: Cystic artery injury: In group-A-(29/272=10.7%) vs (8/236=3.4%) in group–B-. The control of bleeding in group-A-(34%=10/29) vs (100%=8/8) in group-B. Clipping was used to control bleeding in group-A-(5/29=17%) vs (8/8=100%) in group-B-, while electrocoagulation used in group-A-(5/29=17%) vs (0/8=0%) in group-B-. The conversion done in group-A- in (19/272=7%) vs (0/8=0%) group-B- A sizable posterior branch was identified in group-A-(6/272=2.2%) vs (62/236=26.3%) in group–B-.In group–A- the clear identification of the anatomy achieved in (202/272=74%) vs (236/236=100%) in group-B-. The conversion rate due to poor identification of the anatomy or complex anomalies in group-A-(4.4%=12/272) vs (0%) in group-B-.Conversion from LC to OC: The total conversion rate in group–A-(36/272=13.24%) vs (0%) in group-B-.. No mortality reported in our study. Conclusion: This technique significantly minimizes the overall conversion rate in LC. How to Cite this Article Pubmed Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. 2020; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Web Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. http://www.sysrevpharm.org/?mno=10512 [Access: March 29, 2021]. doi:10.31838/srp.2020.10.21 AMA (American Medical Association) Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. 2020; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Vancouver/ICMJE Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. (2020), [cited March 29, 2021]; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Harvard Style Adel Mosa Al-Rekabi (2020) & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP, 11 (10), 123-127. doi:10.31838/srp.2020.10.21 Turabian Style Adel Mosa Al-Rekabi. 2020. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Reviews in Pharmacy, 11 (10), 123-127. doi:10.31838/srp.2020.10.21 Chicago Style Adel Mosa Al-Rekabi. Isolation & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. Systematic Reviews in Pharmacy 11 (2020), 123-127. doi:10.31838/srp.2020.10.21 MLA (The Modern Language Association) Style Adel Mosa Al-Rekabi. Isolation & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. Systematic Reviews in Pharmacy 11.10 (2020), 123-127. Print. doi:10.31838/srp.2020.10.21 APA (American Psychological Association) Style Adel Mosa Al-Rekabi (2020) & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Reviews in Pharmacy, 11 (10), 123-127. doi:10.31838/srp.2020.10.21