How to Secure Cystic Duct Ligation for Laparoscopic Cholecystectomy - Back to Simple Basic
Keywords:cystic duct, ligation, laparoscopic cholecystectomy
AbstractBackground: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic
gallstone. There have been many techniques of cystic duct ligation reported but there are still many
complications due to failure of this ligation. The present study reviewed the outcome of LC performed whereby
cystic duct and artery were ligated by an ordinary silk.
Materials and Methods: This retrospective study reviewed the overall outcome of 121 patients who
underwent LC whereby cystic duct and artery were intracorporally ligated by simple silk. The procedures had
been performed during May 2002- December 2005. The following parameters were analyzed: age, sex, weight,
underlying diseases, previous surgery, diagnosis, anatomy of hepatobiliary system, operation time, length of
stay (LOS), the numbers of intracorporeal knots, complications and follow- up time.
Results: Of 121 patients, 2 patients (1.6%) were converted to open cholecystectomy. The mean age was
53.04 years and the average body weight was 59.45 kg. Ninety three patients (76.9%) were female and 28 patients
(23.1%) were male. The most common diagnosis was symptomatic gallstones without cholecystitis (86.7%).
Gallstones with chronic cholecystitis were found in 8.3%. The average operative time was 61.29 minutes (25-
160). The average LOS was 3.05 days and the average number of intracorporeal knots was 5.12 for each patient.
There were 12 patients who had complications in which the most common was bleeding in 5 patients (4.1%).
Intra-abdominal collection (bile leakage) occurred in one patient (0.8%) and this patient needed re-admission.
There was no main biliary duct injury and mortality.
Conclusion: The intracorporeal ligation of LC was feasible, economical and safe and it could manage
all kinds of cystic ducts. The author suggested the important steps to avoid complications: 1) keep standard 4-
port technique (3 of 5 mm. and 1 of 10 mm.), 2) first dissect posterior peritoneum of the Calot’s triangle,
3) create two windows over the Calot’s triangle, 4) use intracorporeal knotting, and 5) meticulously dissect to
look for anatomical variations.
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