Use of Stapling Devices for Safe Cholecystectomy in Acute Cholecystitis

• Published in: International surgery 2014-09, Vol.99 (5), p.571-576
• Main Authors: Odabasi, Mehmet, Muftuoglu, M. A. Tolga, Ozkan, Erkan, Eris, Cengiz, Yildiz, Mehmet Kamil, Gunay, Emre, Abuoglu, Haci Hasan, Tekesin, Kemal, Akbulut, Sami
• Format: Article
• Language: English
• Subjects: Hepatobillary Surgery
• ISSN: 0020-8868; 2520-2456
• DOI: 10.9738/INTSURG-D-14-00035.1

Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.