Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

ABSTRACT

Introduction: Laparoscopic cholecystectomy today hasbeen rapidly embraced worldwide as the procedure of choicefor cholecystectomy. Conventionally, titanium clips areused to ligate the cystic duct. Recently, various methods ofsuture ligation of the cystic duct both intra corporeal andextra corporeal have been described during laparoscopiccholecystectomy. Only limited number of studies have beencarried out prospectively to compare the various methods. Thepresent study was thus designed to compare clip occlusionversus extra corporeal suture ligation (Roeder knot) of thecystic duct in laparoscopic cholecystectomy.Material and methods: This study was a single blindedrandomized controlled trial conducted on 150 adult patientsundergoing laparoscopic cholecystectomy. They wererandomized into two groups of 75 each to compare theprocedures of clip occlusion versus extracorporeal sutureligation (Roeder knot) of the cystic duct with respect to theoperative time, complications, associated morbidity, operativecost and hospital stay.Results: There was no significant (p>0.05) differencein duration of surgery between the groups (Clipligation=40.44±4.63 minutes, suture ligation=43.32±4.44minutes). Bile leakage due to slippage of ligature was presentin 2 (2.7%) patients with clip ligation as compared to 0% insuture ligation. This difference was found to be statisticallysignificant (p=0.03). Obstructive jaundice due to accidentalligation of CBD was present in 2 (2.7%) patients with clipligation as compared to 0% in suture ligation. This differencewas also found to be statistically significant. (p=0.03). Thecost of Clip ligation (Rs.369.07±8.08) was higher than sutureligation (Rs.300.00±0.00).Conclusion: The results of this study indicate thatextracorporeal (Roeder’s knot) is a safe, cost effectivealternative with a low complication rate as compared totitanium clip ligation of the cystic duct in laparoscopiccholecystectomy