INTRODUCTION: Comparison of sealers used in laparoscopic cholecystectomy for cystic duct closure:
An ex vivo study
METHODS: In this prospective study, 90 patients with symptomatic gallstone disease were operated using laparoscopic technic. Then gallbladders were divided into three groups (n=30). In all groups, gallbladders were removed with surgical clips. After the gallbladders removed, in first group, cystic ducts remain clipped (SC). In second and third groups, cystic ducts were sealed with HS and PK distally after the surgical clips removed. Then, twentygauge catheters were applied to fundic part of gallbladder and gallbladders filled with saline. An increasing pressure was applied through a sphygmomanometer. Bursting pressures were measured using invasive arterial blood pressure measurement device and measured systolic pressures were accepted bursting pressure. After bursting pressures were measured in three groups, results were written down to the SPSS table. Differences between HSvsSC, HSvsPK and SCvsPK groups were calculated using pairedsamples ttest.
RESULTS: In this study, the mean cystic duct bursting pressures were 332.46±4.62 mm Hg with SC, 326.56±4.53 mmHg with PK and 343.06±4.28 mm Hg with HS. Differences in the mean cystic duct bursting pressures between HS vs. SC and HS vs. PK groups were indicated HSs superiority (p=0.046 and p=0.026, respectively). On the contrary, SC vs. PK group was not indicated PKs advantage; however, PK was found safely as much as SC.
DISCUSSION AND CONCLUSION: HS and PK sealer could be an alternative and safe method for cystic duct closure, avoiding the clip displacement and migration of the clip. Single device usage was one of the most important advantages of this technique. Thus, intraabdominal organ injuries will be lessened.