Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

Abstract

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

Evaluation of the safety of using harmonic scalpel during laparoscopic cholecystectomy in children: A preliminary report

“…Nonetheless, these clips can migrate into neighboring structures, resulting in strictures due to foreign body response, act as a nidus for stone formation, and occasionally fall off leading to substantial morbidity ( 6 , 7 ). Although non-popular, many surgeons prefer to ligate the cystic duct using absorbable sutures to avoid such complications; however, this adds to the length of the procedure adding a technically demanding step in order to perform the three intracorporeal sutures ( 8 ).…”

A Comparative Study between Metal Clip Application and Suture Ligation of Cystic Duct in Laparoscopic Cholecystectomy

“…The difference was statistically significant (p<0.05). In Prabu et al 3 study, the cost of polyglactin suture was much cheaper than that of titanium clips used for the cystic duct and artery. For the suture material used during the study, the price was only 250-300 rupees (3.51-4.21 $), whereas for the titanium clips used for clipping it was far higher, reaching 790-1000 rupees (12.28-15.55 $).…”

“…Laparoscopic cholecystectomy is accepted as the ''gold standard'' surgical treatment of gall stone diseases due to its optimal postoperative results and enhanced quality of life 1,2 . Cholecystectomy is the second most commonly performed intra-abdominal operation worldwide after appendicectomy 3 . It is the commonest performed laparoscopy worldwide 4 .…”

“…Prabu et al3 reported total of 70 patients were included in the study. 67% of the patients were female and 33% were male.…”