Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan

Abstract

Background: Laparoscopic cholecystectomy has become the procedure of choice in the management of gall stone diseases which is commonly performed using titanium clips. Harmonic scalpel is an option for the clipless surgery. The objective of the study was to compare the efficacy of clipless cholecystectomy using harmonic scalpel and clipped conventional laparoscopic cholecystectomy.
Material and Methods: This randomized controlled trial was conducted at Nishtar Hospital Multan, Pakistan from October 1st 2019 to March 31st 2020. Total 188 patients of gallstone related cholecystitis were enrolled in the study. Patients were divided by simple randomization into two equal groups for clipless and the conventional clipped laparoscopic cholecystectomy, respectively. Age, gender, duration of cholecystitis, duration of procedure, hospital stay, usefulness in difficult procedures and biliary leakage were recorded for all the patients. Data was compared between the two groups by applying Student t-test on quantitative variables and Chi square test on the qualitative variables.
Results: Mean operation time was more for clipped (28.35±7.92 minutes) as compared to clipless cholecystectomy (21.15±4.47 minutes) (P < .001). Mean hospital stay was 2.37±0.60 days in clipped surgery group and 1.71±0.74 days in clipless surgery group (P < .001). Biliary leakage was reported in 2 (2.1 %) patients of the clipped group and 1 (1.1%) patient of the unclipped group (P = .561). Clipless procedure was found to be more useful in difficult cases (n=8; 8.5%) as compared to the clipped cholecystectomy (P = .004).
Conclusions: The results in the current study show that clipless surgery is a better option as compared to the clipped conventional laparoscopic cholecystectomy, as it is associated with a shorter operating time and hospital stay along with better usefulness in difficult cases.