COMPARISON BETWEEN CLIPLESS LAPAROSCOPIC CHOLECYSTECTOMY VERSUS CONVENTIONAL METHODS IN PATIENTS OF SYMPTOMATIC GALLSTONES

Abstract

Background: Laparoscopic cholecystectomy is the worldwide gold standard treatment of symptomatic
gallbladder lithiasis. The sealing device has been used safely in other general surgical operations. The
primary use of clipless with sealing device in laparoscopic cholecystectomy was for the division of the
cystic artery. Now, Blade tip provide for the reliable ultrasonic division and closure of the cystic duct.
The aim of the current study was achieving safe closure and prevention of post-operative
complications by using cipless laparoscopic cholecystectomy. Patients and methods: This study
included 30 patients with uncomplicated gallstone diseases. All patients were diagnosed to be
uncomplicated gallstone disease patients. Patients were operated within 6 months duration in Zagazig
University Hospital. History taking, clinical examination and full investigations were done. A definite
diagnosis is confirmed by using ultrasonography. All patients with comorbid diseases were fully
optimized and well prepared for the surgery. Results: There is statistically significant difference
between the studied groups regarding operative time. Mean operative time is significantly higher
among conventional laparoscopic cholecystectomy group. There is statistically highly significant
difference between the studied groups regarding length of hospital stay (significantly longer among
patients underwent Clipless Laparoscopic harmonic Cholecystectomy). There is statistically nonsignificant difference between the studied groups regarding VAS preoperatively. There is statistically
significant difference between the studied groups regarding VAS postoperatively (significantly lower
in Clipless Laparoscopic harmonic Cholecystectomy). In each group, VAS significantly decreased
postoperatively. There is statistically significant difference between the studied groups regarding need
for conversion to conventional technique by clipping cystic duct. No conversion to open
cholecystectomy in both groups. Conclusion: Sealing device provides complete hepatobiliary stasis
for all patients and is a safe alternative to stander clip of cystic duct and artery. It provides a shorter
operative duration, less incidence of gallbladder perforation, and less rate of conversion to open
cholecystectomy avoiding clip failure less thermal effect on the liver especially fatty or early cirrhotic.