Skip to main content

An audit of cystic duct closure in laparoscopic cholecystectomies

Surgical Endoscopy And Other Interventional Techniques volume 20, pages 875–877 (2006)Cite this article

Abstract

Background

Cystic duct leak is an infrequent but potentially serious complication of laparoscopic cholecystectomy. The aims of this audit were to assess the efficacy of locking absorbable clips for closing the cystic duct and to compare the results with those for simple clips used previously.

Methods

The records for all laparoscopic cholecystectomies performed in one hospital over a 5-year period were reviewed. The results were compared using Fisher’s exact test.

Results

Of 518 laparoscopic cholecystectomies attempted, 24 were excluded. There was no difference in age or sex ratio between the two groups. Cystic duct leaks were identified either on endoscopic retrograde choloangio pancreatography or at laparotomy. No cystic duct leak occurred in any of the 344 locking clip cases, as compared with 3 leaks in the 146 (2%) simple clip cases (p < 0.03).

Conclusion

Locking clips are a safe and effective method for cystic duct closure. They are associated with a reduced cystic duct leak rate, as compared with that for simple clips.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Adamsen S, Hansen OH, Jensen PF, Schulze S, Stage JG, Wara P (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 184: 571–578

    PubMed  CAS  Google Scholar 

  2. Cetta F, Baldi C, Lombardo F, Monti L,Stefani P,Nuzzo G (1997) Migration of metallic clips used during laparoscopic cholecystectomy and formation of gallstones around them: surgical implications from a prospective study. J Laparoendosc Adv Surg Tech A 7: 37–46

    PubMed  CAS  Article  Google Scholar 

  3. Clarke-Pearson DL, Creasman WT (1985) A clinical evaluation of absorbable polydiaxanone ligating clips in abdominal and pelvic operations. Surg Gynecol Obstet 161: 250–252

    PubMed  CAS  Google Scholar 

  4. Geissler B, Lindemann F, Hausser L, Witte J (1998) Dislocation of clips of the cystic duct stump Zentralbl Chir 123:102–105

    PubMed  Google Scholar 

  5. Huang X. Feng Y. Huang Z (1997) Complications of laparoscopic cholecystectomy in China: an analysis of 39,238 cases. Chinese Med J 110:704–706

    CAS  Google Scholar 

  6. Leung KL, Kwong KH, Lau WY, Chung SC, Li AK (1996) Absorbable clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Endosc 10: 49–51

    PubMed  CAS  Article  Google Scholar 

  7. McMahon AJ, Fullarton G, Baxter JN, O’Dwyer PJ (1995) Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 82: 307–313

    PubMed  CAS  Google Scholar 

  8. Michel F, Ponsot Y, Roland J, Thibault P, Rouquette AM , Gattego B (1985) Biological tolerance to polydiaxanone absorbable clips: a comparison with metallic ligating clips. Eur Surg Res 17: 383–387

    PubMed  CAS  Google Scholar 

  9. Miroshnik M, Saafan A, Koh S, Farlow J, Neophyton J, Lizzio J, Yee F, Ethell T, Bean A, Fenton-Lee D (2002) Biliary tract injury in laparoscopic cholecystectomy: results of a single unit. ANZ J Surg 72: 867–870

    PubMed  Article  Google Scholar 

  10. Muhe E (1986) Die erste Cholecystektomie durch das Laparoskop: English summary. Langenbecks Arch Klin Chir 369: 804

    Google Scholar 

  11. Nathanson LK, Easter DW, Cuschieri A (1991) Ligation of the structures of the cystic pedicle during laparoscopic cholecystectomy. Am J Surg 161: 350–354

    PubMed  CAS  Article  Google Scholar 

  12. Reynolds W Jr (2001)The first laparoscopic cholecystectomy. J Soc Laparoendosc Surg 5:89–94

    Google Scholar 

  13. Schaefer CJ, Colombani PM, Geelhoed GW (1982) Absorbable ligating clips. Surg gynecol Obstet 154: 513–516

    PubMed  CAS  Google Scholar 

  14. Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Starocik RN, Schwartz JS, Williams SV (1996) Mortality and complications associated with laparoscopic cholecystectomy. Ann Surg 224: 609–620

    PubMed  CAS  Article  Google Scholar 

  15. Weishaupt D, Quick HH, Nanz D, Schmidt M, Cassina PC, Debatin JF (2000) Ligating clips for three–dimension MR angiography at 1.5 t in vitro evaluation. Radiology 214: 902–907

    PubMed  CAS  Google Scholar 

  16. Westervalt J (2004) Clipless cholecystectomy: broadening the role of the Harmonic scalpel. J Soc Laparoendosc Surg 8: 283–285

    Google Scholar 

  17. Wise US, Glick GL, Landeros M (1996) Cystic duct leak after laparoscopic cholecystectomy: a multiinstitutional study. Surg Endosc 10: 1189–1193

    Article  Google Scholar 

  18. Yano H, Okada K, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Monden T (2003) Efficacy of absorbable clips compared with metal clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Today 33: 18–23

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, Royal Cornwall Hospital, Treliske TR1 3LJ, Cornwall, United Kingdom

    A. Rohatgi & A.L. Widdison

Authors
  1. A. Rohatgi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A.L. Widdison
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Accepted for presentation at AESGBI, Hull, 18 November 2002, World Congress of Digestive Surgery, Hong Kong, December 2002

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rohatgi, A., Widdison, A. An audit of cystic duct closure in laparoscopic cholecystectomies. Surg Endosc 20, 875–877 (2006). https://doi.org/10.1007/s00464-004-2253-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-2253-9

Keywords

  • Absorbable clips
  • Cystic duct leak
  • Laparoscopic cholecystectomy