Published online Jan 27, 2020. doi: 10.4240/wjgs.v12.i1.9
Peer-review started: June 19, 2019
First decision: August 2, 2019
Revised: October 19, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: January 27, 2020
Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures. Cystic stump leakage is an underestimated, potentially life threatening complication and still occurs in 1%-6% of the patients. If a secure cystic duct occlusion technique can be found bile leakage becomes a preventable complication and morbidity from LC significantly reduced. With our study we believe to contribute to a reduction in bile leakage rates.
The main topic is cystic stump leakage complication after LC. The key problem is that this complication is underestimated and still occurs in 1%-6% of patients. We can solve this unnecessary complication by finding a secure cystic duct closure technique. As yet data on cystic duct closure technique is scars, using a polydioxanone (PDS) loop has not been described in a significant cohort yet. We find the use of a loop very promising and an interesting topic for future research.
To investigate the effect of PDS loop closure of the cystic duct on bile leakage rate in LC patients and compare bile leakage complication with the conventional clipped closure technique in patients with and without increased bile leakage risk. We show that PDS loop closure is a safe closure technique, as 0% bile leakage complications occurred even in high risk patients; whereas, in clipped closure patients the bile leakage rate increased from 0.9 up to 13%, dependent upon the bile leakage risk. PDS loop closure technique deserves more attention.
In this retrospective analysis of a prospective cohort, the effect of PDS loop closure of the cystic duct on bile leakage complication was compared to patients with conventional clip closure. Logistic regression analysis was used to develop a risk score to identify bile leakage risk. Leakage rate was assessed for categories of patients with increasing levels of bile leakage risk. This is a novel approach to the problem.
We show that PDS loop closure is a safe closure technique, as 0% bile leakage complications occurred even in high risk patients; whereas, in clipped closure patients bile the leakage rate increased from 0.9% up to 13%, dependent upon the bile leakage risk. PDS loop closure technique deserves more attention. This study contributes to a more secure cystic duct closure technique during LC and can motivate to further investigate this closure technique to increase the level of evidence.
Cystic duct closure with a PDS loop during LC may reduce bile leakage in patients at increased risk for bile leakage.
PDS loop is a potential secure cystic duct closure technique with no bile leakage complication risk even in high-risk patients. A change in cystic duct closure technique has already been implemented in our institution. The conventional clipped closure technique is not used in patients at risk for bile leakage complication. Randomised controlled trial or large prospective multicentre cohort.