ABSORBABLE CLIPS FOR CYSTIC DUCT LIGATION IN LAPAROSCOPIC CHOLECYSTECTOMY

Background: The efficacy and applicability of an absorbable polydioxan one (PDS) clip for cystic duct ligation were evaluated in 297 patients undergoing laparoscopic cholecystectomy. Methods: The indications for cholecystectomy were symptomatic gallstones (179 patients), acute cho lecystitis (67), biliary pancreatitis (23), acute cholangitis (24), an d gallbladder polyp (4). Results: Twenty-five patients required conver sion to open surgery (8.4%). The conversion rate was 2.7% for uncompli cated and 17.5% for complicated gallbladder diseases. Of the 272 patie nts with laparoscopic cholecystectomy, the cystic ducts were successfu lly ligated with PDS clips in 227 patients (83.5%). The success rate w as higher in uncomplicated (163/178) than in complicated (64/94) gallb ladder diseases (chi square 24.6, P < 0.001). There was no clip-relate d complication on follow-up (range 0.4-39.2, median 17.5 months). In 4 5 patients, PDS clip failed. They were treated with endoloop (14 patie nts), Roeder slip knot (13), metallic clips and endoloop (8), metallic clips alone (6), and intracorporeal tie (4). Conclusions: The PDS cli p is effective and applicable to the majority of patients. It should b e attempted first because of the ease of application.