ORIGINAL ARTICLE

Tie versus clipping typed of cystic duct and artery ligation in laparoscopic cholecystectomy

Deari Ahmad Ismaeil , Fazladdin N. Shkor, Abdulwahid Mohammed Salih, Muhsin Muhammad Ahmed, Ary Hama Said, Halkawt Omar Ali, Hardi Kareem Jalal

Deari Ahmad Ismaeil
Assistant professor, Department of Surgery, Medical College, University of Sulaimani, Sulaimani , Kurdistan region /Iraq. Email: [email protected]

Fazladdin N. Shkor
Lecturer, Department of Nursing, Sulaimani Poly-technic University, Sulaimani , Kurdistan Region, Iraq

Abdulwahid Mohammed Salih
Assistant Professor, Department of Surgery, Medical College, University of Sulaimani, Sulaimani , Kurdistan region /Iraq

Muhsin Muhammad Ahmed
General Surgeon, Department of Surgery, Teaching Hospital, Sulaimani, Ministry of Health, Kurdistan region /Iraq

Ary Hama Said
Lecturer, Department of Community Medicine, Medical College, University of Sulaimani, Sulaimani , Kurdistan region /Iraq

Halkawt Omar Ali
Senior House Officer, Department of Surgery, Teaching Hospital, Sulaimani, Ministry of health, Kurdistan region /Iraq

Hardi Kareem Jalal
Senior house officer, department of surgery, teaching hospital, Sulaimani, Ministry of health, Kurdistan region /Iraq
Online First: August 01, 2020 | Cite this Article
Ismaeil, D., Shkor, F., Salih, A., Ahmed, M., Said, A., Ali, H., Jalal, H. 2020. Tie versus clipping typed of cystic duct and artery ligation in laparoscopic cholecystectomy. Bali Medical Journal 9(2): 556-561. DOI:10.15562/bmj.v9i2.1822


Background: In laparoscopic cholecystectomy (LC) cystic duct and cystic artery (CD-CA) are usually secured by using Titanium clips. Because of some complications may occur in application of clips; like dislodgement and migration of the clips, so other different techniques have been used, like intra or extracorporeal ligation, using of absorbable clips, harmonic scalpel or LigaSure. Intra-corporeal ligation takes more time than applying a clip, and it needs well training. In the other hand clipping have a challenge in cases with wide cystic duct. The objective of the study is to compare the efficacy and safety of suture ligation versus clipping, in securing CD-CA in LC, and also time difference of operations in both methods.

Methods: A Prospective study included 94 females, and 32 males underwent LC; in 51 patients CD-CA were secured by intra-corporeal ligation separately, and in 75 patients CD-CA were secured by Titanium clips. Postoperatively the patients followed up in the outpatient clinic at the end of the first and second postoperative weeks for any complication.

Results: There were no significant differences in the operation times between the two groups (p-value: 0.08), and also no significant difference found between the operation times and the different presentations, history of upper abdominal surgery, present of umbilical hernias, and different BMI. There was no per-operative bile duct injury and no postoperative bile leak, intraperitoneal collection, or jaundice, in both groups.

Conclusion: Suture ligation for CD-CA is safe and effective. Learning intra-corporeal knotting is important and plays an important role even in addition to the use of the clipping, and should be the recommended training in basic laparoscopic surgery.

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