Closure of the Cystic Duct During Laparoscopic Cholecystectomy in Children Using the LigaSure Vessel Sealing System

• Published in: World journal of surgery Vol. 35; no. 1; pp. 212 - 216
• Main Authors: Turial, Salmai, Engel, Veronika, Sultan, Tamer, Schier, Felix
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 2011; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Biliary Leakage; Biological and medical sciences; Cardiac Surgery; Child; Cholecystectomy, Laparoscopic - instrumentation; Common Bile Duct; Cystic Duct; Cystic Duct - surgery; Electrocoagulation - instrumentation; Female; General aspects; General Surgery; Harmonic Scalpel; Humans; Laparoscopic Cholecystectomy; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Medicine; Medicine & Public Health; Prospective Studies; Splenectomy; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Young Adult; Cystic Duct; Biliary Leakage; Harmonic Scalpel; Common Bile Duct; Laparoscopic Cholecystectomy; Human; Cholecystectomy; Medicine; Endoscopic surgery; Treatment; Closure; Digestive system; Cystic duct; Blood vessel; Gallbladder; Circulatory system; Child
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0813-9

Background The goal of the present study was to evaluate the efficacy of the LigaSure ™ Vessel Sealing System (LVSS) when used for cystic duct closure during laparoscopic cholecystectomy in children and adolescents. Methods The laparoscopic cholecystectomy was performed beginning with visualization of Calot’s triangle, and dissection of Calot’s triangle was achieved using a monopolar cautery device. Once the cystic duct was exposed, sealing was performed proximally and distally, and the cystic duct was divided midway using the LVSS. The procedure was completed in the standard fashion. Results The closure of the cystic duct was performed in seven cases of simultaneous cholecystectomy and splenectomy and in 15 cases of microlaparoscopic cholecystectomy. The patients’ ages ranged from 7 to 21 years (average = 14.5 years), and body weight ranged from 42 to 83 kg (average = 58 kg). There was no bile leakage noted, and the closure of the cystic duct was sufficient in all cases. We noted one case of common bile duct obstruction on postoperative day 1. In this case, an exploration of the biliary tree was performed by laparotomy. No direct injury to the common bile duct was found during exploration, but thermal changes were detected in the surrounding tissues as a result of transmitted thermal energy caused by bipolar cautery device. Conclusion The closure of the cystic duct using the LVSS is feasible and effective in laparoscopic cholecystectomy in children. However, it is important to keep a safe distance from other intra-abdominal structures when using thermal energy devices to prevent thermal collateral damage.