Cystic Duct Ligation in Laparoscopic Cholecystectomy: A Comparison Study of Metallic Clips and Ligatures
DOI:
https://doi.org/10.48047/Keywords:
Laparoscopic Cholecystectomy, Cystic Duct Ligation, Suture Ligation, Metal Clip LigationAbstract
Background: The present study was conducted to compare the efficacy and safety of ligature application with metallic clip
application for cystic duct ligation in laparoscopic cholecystectomy. Methods: This was a cross-sectional study conducted between May 2021 and May 2022 for a duration of 12 months among patients undergoing laparoscopic cholecystectomy (elective or emergency) for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition) in the Department of General Surgery, PSG Hospitals, Coimbatore. Patients were assigned to either Group A (cystic duct occlusion with ligatures) or Group B (cystic duct occlusion with metallic clips).
Results: The study found significantly less operating time in the clip group compared to the ligature group. The mean clip/ligature time of the ligature group was 12.30 ± 4.36, and that of the clip group was 8.67 ± 2.87. The mean difference in the clip/ligature time between the study groups was statistically significant, with a p-value of <0.001. We found a significantly shorter time to clip the ligation of the cystic duct as compared to the ligature technique. Both groups found all subjects to have no post-op complications or interventions. In both groups, the median hospital stay was 3 days (IQR 2.0 to 3.0), p-value 0.3589. The surgery and post-surgery follow-up of 1 month were uneventful in both groups.
Conclusions: Metal clips are frequently used to tie up the cystic duct, but they have their own limitations and complications. There are equally effective alternative methods available. One such method is the simple, safe, and economical suture ligation of the cystic duct. Although the use of ligatures is associated with a longer duct occlusion time and thereby total surgical duration and also needs greater surgical expertise, they can be used as an equivalent alternative to clips, especially in patients with wide and short cystic ducts
