New Technique of Clipless Laparoscopic Cholecystectomy

Ahmed A Elgeidie

doi:10.4236/ss.2012.36061

Abstract

Background: In laparoscopic cholecystectomy (LC), application of clips is the standard method for controlling the cystic duct and artery. However, this is not without problems. We propose a modified technique for management of cystic duct and artery in LC. Methods: Since 2007, 328 patients presented with symptomatic gallstones were included. In those patients, the cystic artery was divided by monopolar cautery and the cystic duct was ligated intracorporeally using nonabsorbable suture. Results: Three patients (0.9%) have bleeding from cauterized cystic artery; bleeding was controlled by diathermy in two of them and application of metal clip was necessary in the remaining patient. Cystic duct leak was detected in only one patient (0.3%), and it was managed by percutaneous drainage. At follow up we did not encounter abnormalities suggestive of bile duct stricture. Conclusion: The proposed modification of LC is feasible, practical, safe and economic as well. It is associated with reduced risk of postoperative morbidity.

Highlights

There is no doubt that laparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic gallstones disease [1,2]
Cystic duct leak was diagnosed in only one patient (0.3%)
Simple metal clips have been used by most surgeons to close the cystic duct since Muhe reported the first successful LC in 1985 [3,12] the use of simple metal clips has many disadvantages

Summary

Introduction

There is no doubt that laparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic gallstones disease [1,2]. Application of clips is associated with some problems These include dislodgement of the clip or bile duct necrosis resulting in postoperative cystic duct leak [3,4,7,11,12]. Another clip-related problem was reported at long term follow up, which is late postcholecystectomy clip migration. Alternative techniques have included the use of locking absorbable clips, [17,18] and the Harmonic Scalpel [19,20]. We describe a novel technique for dealing with cystic duct and artery during LC

Operative Technique

Results

Discussion