EFFICACY OF SILK SUTURES COMPARED WITH NON-ABSORBABLE POLYMER CLIPS FOR CYSTIC DUCT LIGATION IN LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY.

Background: Laparoscopic cholecystectomy (LC) is the gold standard in gallbladder removal surgery. Despite the drastic improvement LC has to offer, there is still much debate regarding the most effective method in ligating cystic duct and cystic artery during LC. Non-absorbable polymer clips (Hem-o-lok) are easy to use and do not cause artifacts during CT/MRI scans but the cost is very high. This study has suggested to use non-absorbable suture materials (silk sutures) for ligation as surgical knots are easy to apply, secure and the cost is significantly lower. Objective: To evaluate the efficacy of silk sutures in ligating the cystic duct comparison post-operative bile leakage with non-absorbable polymer clips. Furthermore, operative times, post-operative complications and the cost were into consideration. Materials & Methods: A prospective randomized controlled trial study of 90 patients who had indications for LC between September 2017 and November 2018 were carried out. Silk sutures (size 2-0) were used in Group A, while Group B received non-absorbable polymer clips. Demographic and intra-operative data were recorded. Post-operative complications such as bile leakage, surgical site infection or pancreatitis were noted if present. Liver function tests were repeated 2 weeks and 3 months after surgery. If patients experienced post-operative abdominal pain, constipation, fever or jaundice; ultrasound was recommended. Results: No statistically significant difference were observed in post-operative complications, hospital stays, operating times and intra-operative blood loss between silk sutures and non-absorbable polymer clips. None of LC procedures were converted into open cholecystectomy and none of post-operative complications had bile leakage. Only 1 case was re-admitted during follow up 2 weeks after surgery that was diagnosed dyspepsia. Conclusion: Ligating cystic duct and artery with silk sutures during LC proved to be as successful and effective as that of non-absorbable polymer clips, in terms of safety, operative times, post-operative complications and costs. [ABSTRACT FROM AUTHOR]