@article{Jongsiri_2009, title={How to Secure Cystic Duct Ligation for Laparoscopic Cholecystectomy - Back to Simple Basic}, volume={30}, url={https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227736}, abstractNote={<div><strong>Background:</strong> Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic<br>gallstone. There have been many techniques of cystic duct ligation reported but there are still many<br>complications due to failure of this ligation. The present study reviewed the outcome of LC performed whereby<br>cystic duct and artery were ligated by an ordinary silk.</div> <div><br><strong>Materials and Methods:</strong> This retrospective study reviewed the overall outcome of 121 patients who<br>underwent LC whereby cystic duct and artery were intracorporally ligated by simple silk. The procedures had<br>been performed during May 2002- December 2005. The following parameters were analyzed: age, sex, weight,<br>underlying diseases, previous surgery, diagnosis, anatomy of hepatobiliary system, operation time, length of<br>stay (LOS), the numbers of intracorporeal knots, complications and follow- up time.</div> <div><br><strong>Results:</strong> Of 121 patients, 2 patients (1.6%) were converted to open cholecystectomy. The mean age was<br>53.04 years and the average body weight was 59.45 kg. Ninety three patients (76.9%) were female and 28 patients<br>(23.1%) were male. The most common diagnosis was symptomatic gallstones without cholecystitis (86.7%).<br>Gallstones with chronic cholecystitis were found in 8.3%. The average operative time was 61.29 minutes (25-<br>160). The average LOS was 3.05 days and the average number of intracorporeal knots was 5.12 for each patient.<br>There were 12 patients who had complications in which the most common was bleeding in 5 patients (4.1%).<br>Intra-abdominal collection (bile leakage) occurred in one patient (0.8%) and this patient needed re-admission.<br>There was no main biliary duct injury and mortality.</div> <div><br><strong>Conclusion:</strong> The intracorporeal ligation of LC was feasible, economical and safe and it could manage<br>all kinds of cystic ducts. The author suggested the important steps to avoid complications: 1) keep standard 4-<br>port technique (3 of 5 mm. and 1 of 10 mm.), 2) first dissect posterior peritoneum of the Calot’s triangle,<br>3) create two windows over the Calot’s triangle, 4) use intracorporeal knotting, and 5) meticulously dissect to<br>look for anatomical variations.</div>}, number={1-2}, journal={The Thai Journal of Surgery}, author={Jongsiri, Narongsak}, year={2009}, month={Jun.} }