A Comparative Study Of Extra Corporeal Knotting Versus Clips For Ligating Cystic Duct In Laparoscopic Cholecystectomy.

Abstract

AIMS AND OBJECTIVE OF STUDY The aims of present study are as following: To compare extracorporeal knotting versus clips for ligating cystic duct in laparoscopic cholecystectomy in terms of: Feasibility Operative time (incision to closer) based on types of cholecystitis Post-operative pain Operative cost Associated morbidities like Gall bladder perforation, Bile leak, Liver bed injury, Port site infection, Migration of clips, Slipping of knot. MATERIALS AND METHODS It is a randomized prospective study done in patients who undergo laparoscopic cholecystectomy in Department of Surgery, B.L.D.E. (DEEMED TO BE UNIVERSITY) SHRI B.M. PATIL MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTRE, VIJAYAPURA– 586103, KARNATAKA. All the patients will be assigned by randomization into either of two groups: Study Group: Patients in whom extracorporeal knotting will be done for ligation of cystic duct. Control Group: Patients in whom clips will be used for clipping of cystic duct. DocuSign Envelope ID: 4D366DEA0B095073-F-CD1A0DD--44ED938E-B-8E4480D-0-5C26D0DA4AD4A04949480C7 X RESULTS Out of 60 patients, In the study group there were no intraoperative complications noted among the 30 patients. In the control group, 11 patients there were intraoperative complications, 7 patients had clip slippage and stone spilling in to the peritoneal cavity from the gall bladder, 3 patients had clip slippage and bile spillage in to the peritoneal cavity from the gall bladder and in 1 patient there was clip migration. In the study group mean time taken for the operation was 67.37 minutes when compared to control group of 61.83 minutes. The average cost of the Suture material used in study group is 302 rupees and the average cost of the Titanium clips used in control group is 500 rupees. CONCLUSION In laparoscopic cholecystectomy, extracorporeal knotting has the advantage over clipping of cystic duct in terms of operative cost and lesser intraoperative complications, with the only limitation being operative time