Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2020; 12(1): 9-16
Published online Jan 27, 2020. doi: 10.4240/wjgs.v12.i1.9
Bile leakage after loop closure vs clip closure of the cystic duct during laparoscopic cholecystectomy: A retrospective analysis of a prospective cohort
Sandra C Donkervoort, Lea M Dijksman, Aafke H van Dijk, Emile A Clous, Marja A Boermeester, Bert van Ramshorst, Djamila Boerma
Sandra C Donkervoort, Emile A Clous, Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam 1090 HM, Netherlands
Lea M Dijksman, Bert van Ramshorst, Djamila Boerma, Department of Research and Epidemiology, St. Antonius Hospital, Nieuwegein 3435 CM, Netherlands
Aafke H van Dijk, Marja A Boermeester, Department of Surgery, Academic Medical Centre, Amsterdam 1105 AZ, Netherlands
Author contributions: Donkervoort SC designed the study and wrote the manuscript; Dijksman LM performed the statistical analysis and deducted a risk score; van Dijk AH collected the data and reference articles; Clous EA collected the data; Boermeester MA helped write the manuscript with emphasis on how to present the findings; van Ramshorst B critically reviewed the presented data; Boerma D co-designed the study and helped write the manuscript.
Institutional review board statement: The subject of this study concerns usual care without an intervention. The study was reviewed and approved by the MEC OLVG Institutional Review Board.
Informed consent statement: The subject of this study concerns usual care without an intervention. An informed consent was not applicable to our study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sandra C Donkervoort, MD, PhD, Surgeon, Department of Surgery, Onze Lieve Vrouwe Gasthuis, PO-box 95500, Amsterdam 1090 HM, Netherlands.
Received: June 16, 2019
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
Core Tip

Core tip: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures. Cystic duct leakage is an underestimated, potentially life threatening complication. With a secure cystic duct occlusion technique, bile leakage becomes a preventable complication. Assessing leakage rates for both clipped and looped patients, we found that in clip closure patients, leakage rates increased from 0.9% up to 13% depending upon their bile leakage risk, whereas loop closure patients leakage rates remained 0%, even for patients at highest risk. Cystic duct closure with a polydioxanone loop may well be a secure occlusion technique.