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
Processing time: 193 Days and 13.4 Hours
Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures. Cystic stump leakage is an underestimated, potentially life threatening complication that occurs in 1%-6% of the patients. With a secure cystic duct occlusion technique during LC, bile leakage becomes a preventable complication.
To investigate the effect of polydioxanone (PDS) loop closure of the cystic duct on bile leakage rate in LC patients.
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.
Of the 4359 patients who underwent LC, 136 (3%) underwent cystic duct closure by a PDS loop. Preoperatively, loop closure patients had significantly more complicated biliary disease compared to the clipped closure patients. In the loop closure cohort, zero (0%) bile leakage occurred compared to 59 of 4223 (1.4%) clip closure patients. For patients at increased bile leakage risk (risk score ≥ 1) rates were 1.6% and up to 13% (4/30) for clip closure patients with a risk score ≥ 4. This risk increase paralleled a stepwise increase of actual bile leakage complication for clip closure patients, which was not observed for loop closure patients.
Cystic duct closure with a PDS loop during LC may reduce bile leakage in patients at increased risk for bile leakage.
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.