Système gastro-intestinal et digestif

Abstrait

Closure of the Cystic Duct: Comparison to Harmonic Scalpel Versus Clip Application in Single Incision Laparoscopic Cholecystectomy

Huseyin Yilmaz, Husnu Alptekin, Ilhan Ece, Akın Calisir and Mustafa Sahin

Backround: Single incision laparoscopic cholecystectomy [SILC] is usually performed using titanium clips [TC] for occlusion of the cystic duct and cystic artery. The use of Harmonic scalpel [HS] in SILC to be applied has been reported. In this study we aimed to compare effect of HS and TC application for closure of the cystic duct and artery in patients undergoing SILC.

Methods: Totally 70 patients were operated using SILC technique from May 2011 to Jan 2012. 37 patients underwent single incision laparoscopic cholecystectomy with titanium clips [TC-SILC] and 33 patients underwent single incision laparoscopic cholecystectomy with hormonic scalpel [HS-SILC]. In the TC-SILC group, closure of the cystic duct and artery was achieved by applying simple TC. In the HS-SILC group, HS was used for the closure and division of both cystic duct and artery. Demographics, diagnosis, operative data, complications and length of hospital stay were compared between the two groups.

Results: Patients demographics were not different between the groups. Conversion to open surgery or need of additional port was not necessary in any patient. The operative data were similar in both groups. Superficial wound infection was seen in one patient in TC group which was trated by oral antibiotics. During the follow-up period, one port-site hernia was detected in a patient who underwent TC-SILC.

Conclusions: The HS seems to be a feasible, effective and a safe technique for performing SILC on selected patients. However, complications of TC was thought to be rare in experienced hands, and the cost of HS should be also considered prior to adopting the technique.