Tie versus clipping typed of cystic duct and artery ligation in laparoscopic cholecystectomy

Abstract

Background: In laparoscopic cholecystectomy (LC) cystic duct and cystic artery (CD-CA) are usually secured by using Titanium clips. Because of some complications may occur in application of clips; like dislodgement and migration of the clips, so other different techniques have been used, like intra or extracorporeal ligation, using of absorbable clips, harmonic scalpel or LigaSure. Intra-corporeal ligation takes more time than applying a clip, and it needs well training. In the other hand clipping have a challenge in cases with wide cystic duct. The objective of the study is to compare the efficacy and safety of suture ligation versus clipping, in securing CD-CA in LC, and also time difference of operations in both methods.Methods: A Prospective study included 94 females, and 32 males underwent LC; in 51Â patients CD-CA were secured by intra-corporeal ligation separately, and in 75Â patients CD-CA were secured by Titanium clips. Postoperatively the patients followed up in the outpatient clinic at the end of the first and second postoperative weeks for any complication.Results: There were no significant differences in the operation times between the two groups (p-value: 0.08), and also no significant difference found between the operation times and the different presentations, history of upper abdominal surgery, present of umbilical hernias, and different BMI. There was no per-operative bile duct injury and no postoperative bile leak, intraperitoneal collection, or jaundice, in both groups.Conclusion: Suture ligation for CD-CA is safe and effective. Learning intra-corporeal knotting is important and plays an important role even in addition to the use of the clipping, and should be the recommended training in basic laparoscopic surgery.