SAFETY OF EXTRACORPOREAL KNOT LIGATION OF WIDE CYSTIC DUCT IN LAPAROSCOPIC CHOLECYSTECTOMY AT A THQ HOSPITAL

Abstract

Introduction: Laparoscopic cholecystectomy is the gold standard treatment of cholelithiasis and is a well-known procedure among patients globally because of less post-operative pain and early recovery. Wide cystic duct is one of the challenges which encountered in laparoscopic cholecystectomy and managing it laparoscopically demands expertise and gadgets. Although several studies are available in literature which compared outcomes of knot ligation versus clip ligation of cystic duct in laparoscopic cholecystectomy but, only few studies have discussed the wide cystic duct management and reported the outcomes of suture ligation of wide cystic duct.

Material & Methods: This retrospective study was conducted at Government THQ Hospital Sabzazar, Lahore from May 2021 to October 2023 and included 63 patients with wide cystic duct. Cystic duct was ligated by extracorporeal Roeder's knot in all cases. Patient`s demographics and Outcome were recorded.

Results: Mean age of patients was 41.30±3.92 years. There were 12.69% males and 87.30% females with male to female ratio of 1:6.8. Mean BMI was 32.98±4.01 Kg/m². Previous history of obstructive Jaundice and ERCP was found in 4.76% and 3.17% patients, respectively. There were 36.50% diabetic and (65.07%) hypertensive patients. Mean time taken for extracorporeal Roeder's knot formation and application was 2.01±0.46 min. Bile leak, retained cystic duct stone, sub-hepatic collection, postoperative jaundice and mortality were not observed in any patient.

Conclusion: Extracorporeal knot ligation of wide cystic duct with Vicryl 1 in laparoscopic cholecystectomy is safe.