Gall Bladder Stone in Cirrhotics Clinical Trial
Official title:
Clipless Laparoscopic Cholecystectomy Using Harmonic Scalpel in Cirrhotic Patients a Prospective Randomized Study
This study included group (A) (60 patients with liver cirrhosis and complaining of gall stone) in whom LC was done using traditional method (TM) by clipping both cystic duct and artery and dissection of gall bladder from liver bed by diathermy, and group (B) (60 patients with liver cirrhosis and complaining of gall stone) LC was done using harmonic scalpel (HS) closure and division of both cystic duct, artery and dissection of gall bladder from liver bed by harmonic scalpel. The Intraoperative and postoperative parameters were collected included duration of operation, postoperative pain, and complications.
Under general anesthesia, and same antibiotics (3rd generation cephalosporin) Surgery was
performed using conventional four ports umbilical port, port below xiphoid and two ports
below right costal margin. Pneumoperitoneum at pressure 12 mmHg was used.
In group (A) LC was done using traditional method by dissection of calot's triangle and
clipping of both cystic duct and artery by metal clips. Then dissection of gall bladder from
its bed by hook using electrocautery technique. Finally we insert abdominal drain in
Morrison pouch.
In group (B) LC was done using harmonic ACE (Ethicon Endo-Surgery) by dissection of calot's
and then occlusion of both cystic duct and artery using harmonic ACE. For closure of and
division of cystic pedicle we set the instrument at a power 2 i.e. more coagulation. And
when dissecting the gall bladder from the bed we set it to the level 5 i.e. more cutting
power. And control of any bleeding from the bed using the active blade of harmonic ACE.
Finally we insert abdominal drain in Morrison pouch.
The Intraoperative parameter observed included duration of the operation, bile escape and
volume of blood loss were recorded The patients started oral feeding 8 h postoperatively;
abdominal ultrasound was done for all patients in both groups on day of discharge to show
any collection or free fluid in the abdomen. The patients were usually discharged after
removal of drain, and when the patient surgically free.
Postoperative pain was evaluated at 12 h, 24h, 48, 1 w after operation using a visual analog
scale (VAS)
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment