Laparoscopic Cholecystectomy with Extracorporeal Sliding Knot using Knot Pusher: A Retrospective Study at Mae Fah Luang University Medical Center Hospital
Keywords:
Laparoscopic cholecystectomy, Extracorporeal sliding knot technique, Knot pusherAbstract
Background: The cystic duct and vessels ligation are critical step in laparoscopic cholecystectomy. Various techniques, including clips and knot-tying methods, have been developed to enhance the safety and efficacy of this ligation process.
Objective: This retrospective study endeavors to meticulously examine the efficacy of laparoscopic cholecystectomy performed using the extracorporeal sliding knot technique facilitated by a knot pusher in patients presenting with symptomatic gallstone diseases.
Method: A retrospective analysis of electronic medical records was conducted for cases of laparoscopic cholecystectomy (LC) performed using the extracorporeal sliding knot technique using knot pusher at Mae Fah Luang University Medical Center Hospital between July 2020 and July 2023. Data on patient demographics, surgical time, hospital stay, and postoperative complications were extracted and analyzed.
Results: The study revealed 118 patients, 29 were male (24.6%) and 89 were female (75.4%). The median age was 55.2 years, with a range of 23 to 85 years. The average surgical time was 20 minutes, with a range of 15 to 55 minutes. The average blood loss was 16 mL, with a range of 5 to 120 mL. The average hospital stay was 1.5 days, ranging from 1 to 4 days. Consist with 35% of co-medical diseases which hypertension the most common. No surgical complications were observed in any of the cases.
Conclusion: Laparoscopic cholecystectomy with the extracorporeal sliding knot technique offers an efficient and safe alternative for cystic duct and vessel ligation during gallbladder surgery.
References
Massoumi H, Kiyici N, Hertan H. Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol. 2007; 41: 301 - 5. doi: 10.1097/MCG.0b013e31802c29f2 https://doi.org/10.1097/MCG.0b013e31802c29f2
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995; 180: 101 - 25. PMID: 8000648
McMahon AJ, Fullarton G, Baxter JN, O'Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg. 1995; 82: 307 - 13. doi: 10.1002/bjs.1800820308 https://doi.org/10.1002/bjs.1800820308
Booij KA, de Reuver PR, Yap K, van Dieren S, van Delden OM, Rauws EA, Gouma DJ. Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy. Endoscopy. 2015; 47: 40 - 6. doi: 10.1055/s-0034-1390908. https://doi.org/10.1055/s-0034-1390908
Fong ZV, Pitt HA, Strasberg SM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes. J Am Coll Surg. 2018; 226: 568 - 76.e1. doi: 10.1016/j.jamcollsurg. 2017.12.023 https://doi.org/10.1016/j.jamcollsurg.2017.12.023
Hida Y, Okuyama S, Iizuka M, Katoh H. New technique to ligate enlarged cystic duct using a clip applier during laparoscopy: report of a case. Hepatogastroenterology. 2002; 49: 926 - 7. PMID: 12143243
Abbas IS. Overlapped-clipping, a new technique for ligation of a wide cystic duct in laparoscopic cholecystectomy. Hepatogastroenterology. 2005; 52: 1039 - 41. PMID: 16001625
van Dijk AH, van Roessel S, Boermeester MA. Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy. World J Gastrointest Surg. 2018; 10 (6): 57 - 69. PMID: 30397545 https://doi.org/10.4240/wjgs.v10.i6.57
Kumar H, Seth S, Sharma OK. Clip Occlusion versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy - A Comparative Study. Int J Contemp Med Res. 2020; 7 (3): C6-C9. https://doi.org/10.21276/ijcmr.2020.7.3.29
Seenu V, Shridhar D, Bal C, Parshad R, Kumar A. Laparoscopic cholecystectomy: cystic duct occlusion with titanium clips or ligature? A prospective randomized study. Trop Gastroenterol. 2004; 25: 180 - 3. PMID: 15912981
Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A. 2013; 23: 849 - 54. doi: 10.1089/ lap.2012.0561 https://doi.org/10.1089/lap.2012.0561
Golash V. An experience with 1000 consecutive cystic duct ligation in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2008; 18: 155 - 6. doi: 10.1097/SLE.0b013 e3181685834 https://doi.org/10.1097/SLE.0b013e3181685834
Shah JN, Maharjan SB. Clipless laparoscopic cholecystectomy--a prospective observational study Nepal Med Coll J. 2010; 12: 69-71. PMID: 21222399
Carvalho GL, Silva FW, Silva JS, de Albuquerque PP, Coelho Rde M, Vilaça TG, Lacerda CM. Needlescopic clipless cholecystectomy as an efficient, safe, and cost-effective alternative with diminutive scars: the first 1000 cases. Surg Laparosc Endosc Percutan Tech. 2009; 19: 368-72. doi: 10.1097/SLE. 0b013e3181b7d3c7 https://doi.org/10.1097/SLE.0b013e3181b7d3c7
Victorzon M, Tolonen P, Vuorialho T. Day-case laparoscopic cholecystectomy: treatment of choice for selected patients? Surg Endosc. 2007; 21: 70-3. https://doi.org/10.1007/s00464-005-0787-0
Ji W, Ding K, Wang D, Li N, Li JS. Outpatient versus inpatient laparoscopic cholecystectomy: a single center clinical analysis. Hepatobiliary Pancreat Dis Int. 2010; 9: 60-4.
Berrevoet E, Biglari M, Sinove Y, De Baardemaeker L, Troisi R, de Hemptinne B. Outpatient laparoscopic cholecystectomy in Belgium: what are we waiting for? Acta Chir Belg. 2006; 106: 537-40. https://doi.org/10.1080/00015458.2006.11679947
Kasem A, Paix A, Grandy-Smith S, El-Hasani S. Is laparoscopic cholecystectomy safe and acceptable as a day case procedure? J Laparoendosc Adv Surg Tech A. 2006; 16: 365-8. https://doi.org/10.1089/lap.2006.16.365
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