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

  • Deari Ahmad Ismaeil ,
  • Fazladdin N. Shkor ,
  • Abdulwahid Mohammed Salih ,
  • Muhsin Muhammad Ahmed ,
  • Ary Hama Said ,
  • Halkawt Omar Ali ,
  • Hardi Kareem Jalal ,


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 51 patients CD-CA were secured by intra-corporeal ligation separately, and in 75 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.

Keywords: Laparoscopic cholecystectomy bile duct injury cystic duct ligation intracorporeal knotting

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How to Cite

Ismaeil, D. A., Shkor, F. N., Salih, A. M., Ahmed, M. M., Said, A. H., Ali, H. O., & Jalal, H. K. (2020). Tie versus clipping typed of cystic duct and artery ligation in laparoscopic cholecystectomy. Bali Medical Journal, 9(2), 556–561. https://doi.org/10.15562/bmj.v9i2.1822
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Deari Ahmad Ismaeil
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Fazladdin N. Shkor
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Abdulwahid Mohammed Salih
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Muhsin Muhammad Ahmed
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Ary Hama Said
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Halkawt Omar Ali
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Hardi Kareem Jalal
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