Ligature Technique: A Safe Outcome in Laparoscopic Cholecystectomy

Abstract

Objective: To compare Extracorporeal Sliding knot (ECK) and clip ligation to ligation of the cystic duct in laparoscopic cholecystectomy. Patients and Methods: This study was conducted as prospective randomized study in Jeddah National Hospital in Jeddah Saudi Arabia, in surgical department carried out from June 2018 to June 2019. In the study 100 patients were selected and divided into two groups, in which we compared outcomes of patients in whom Cystic Duct Occlusion was done by clips (Group I n=60) and other group Ligatures endoloop knotting (Group II n=40). During laparoscopic cholecystectomy (LC), cystic duct occlusion can be done with titanium clips or ligature permanently in order to prevent leakage of bile into the peritoneal cavity. Results: Average age of the patients of clipping group was 43.68 years and the average age of the patients of knot group was 42.64 years, with male to female ration as 1:4.5. 1:2.3 of clipping and knot group respectively. Regarding operating time from initial incision to closure of wound is 61 to 65 minutes in clip group and 69 to 70 minutes in knot group. Longer operating times in knot group is due to learning curve effect for most surgeons as is evident from the fact that first twenty surgeries took longer time as compared to subsequent surgeries. The port site infection was in 03 cases of the clip group 01 in the knot group, drain was kept in 12 cases in knot group and 06 in clip group, bile leak requiring ERCP 02 cases in clip group and 01 in knot group, retained CBD Stones 01 was in clip group, obstructive Jaundice was seen in one cases of clip group, while no mortality was seen in both groups. Although the hospital stay after surgery in clip group was 1-2 days and in knot group also 1-2 days and in ERCP patients’ Hospital stay was 2 to 3 days. Conclusion: Cystic duct occlusion with knots/ligatures is a safe, cost effective, less post operative pain alternative to clips as various studies showed clips complications. It also showed less post-operative pain, less bile leak and port site wound infection. Safety of using knots/ligatures is even better than clips as is evident from this study comparing these two methods of cystic duct occlusion. Key words: cholecystectomy, surgical clips, surgical knots, surgical ligature, cystic duct occlusion, bile leakage