Clipless Laparoscopic Cholecystectomy Using Harmonic Scalpel in Cirrhotic Patients a Prospective Randomized Study
Clipless Laparoscopic Cholecystectomy Using Harmonic Scalpel in Cirrhotic Patients a Prospective Randomized Study
This study included group (A) (60 patients with liver cirrhosis and complaining of gall
 stone) in whom LC was done using traditional method (TM) by clipping both cystic duct and
 artery and dissection of gall bladder from liver bed by diathermy, and group (B) (60 patients
 with liver cirrhosis and complaining of gall stone) LC was done using harmonic scalpel (HS)
 closure and division of both cystic duct, artery and dissection of gall bladder from liver
 bed by harmonic scalpel. The Intraoperative and postoperative parameters were collected
 included duration of operation, postoperative pain, and complications.
Under general anesthesia, and same antibiotics (3rd generation cephalosporin) Surgery was
 performed using conventional four ports umbilical port, port below xiphoid and two ports
 below right costal margin. Pneumoperitoneum at pressure 12 mmHg was used.

 In group (A) LC was done using traditional method by dissection of calot's triangle and
 clipping of both cystic duct and artery by metal clips. Then dissection of gall bladder from
 its bed by hook using electrocautery technique. Finally we insert abdominal drain in Morrison
 pouch.

 In group (B) LC was done using harmonic ACE (Ethicon Endo-Surgery) by dissection of calot's
 and then occlusion of both cystic duct and artery using harmonic ACE. For closure of and
 division of cystic pedicle we set the instrument at a power 2 i.e. more coagulation. And when
 dissecting the gall bladder from the bed we set it to the level 5 i.e. more cutting power.
 And control of any bleeding from the bed using the active blade of harmonic ACE. Finally we
 insert abdominal drain in Morrison pouch.

 The Intraoperative parameter observed included duration of the operation, bile escape and
 volume of blood loss were recorded The patients started oral feeding 8 h postoperatively;
 abdominal ultrasound was done for all patients in both groups on day of discharge to show any
 collection or free fluid in the abdomen. The patients were usually discharged after removal
 of drain, and when the patient surgically free.

 Postoperative pain was evaluated at 12 h, 24h, 48, 1 w after operation using a visual analog
 scale (VAS)
Inclusion Criteria:

 -  patients with liver cirrhosis with symptomatic gall bladder stone

 Exclusion Criteria:

 -  patients above 80 years old,

 -  patients with history of upper laparotomy,

 -  patients with common bile duct stones

 -  and pregnant females.