Laparoscopic cholecystectomy: retrospective comparative evaluation of titanium versus absorbable clips.
We present a retrospective study of the use of titanium and absorbable clips during laparoscopic cholecystectomy. The aim was to determine any differences in outcome and costs. From January 1999 to February 2002, 690 patients who had successfully undergone a laparoscopic cholecystectomy were reviewed. According to the type of clip, we retrospectively identified two groups of patients: 199 in whom the surgeons had used absorbable clips (absorbable clip group, ACG) and 491 in whom the surgeons had used titanium nonabsorbable clips (titanium clip group, TCG). Data about demographics, operation, results, complications, and follow-up were collected and matched in the two groups. Demographics, concomitant surgery, and the American Society of Anesthesiologists (ASA) status were comparable between the two groups. Although the proportions of cases requiring urgent operation, intraoperative cholangiography, use of a fourth trocar, and use of drainage suction were similar, the difficulty score of the operation was lower (6.3 vs. 7.0, P =.03) and the operative time was shorter (44 vs. 61 minutes, P <.0001) in the ACG than in the TCG. Complications, hospital stay, and long-term results were satisfactory and comparable between the two groups. No correlation was found between clip type and the incidence of biliary tree injuries, bleeding, wound infection, or readmission. The cost of the two types of clips varied slightly (90 euros for each procedure). Despite the fact that absorbable clips are theoretically less likely to cause complications than metallic ones, we were not able to demonstrate any clinical advantage during laparoscopic cholecystectomy in this retrospective study. Furthermore, the results suggest that absorbable clips are preferred when the cholecystectomy presents fewer difficulties.
First Division of General Surgery and Transplantation, Careggi Main Academic and Teaching Hospital, Florence, Italy. lapbenc@tin.it
Lapo
L
Bencini
Bernardo
B
Boffi
Marco
M
Farsi
Luis Josè
LJ
Sanchez
Marco
M
Scatizzi
Renato
R
Moretti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013525:Surgical Instruments / Q000009:adverse effects; D014025:Titanium; D016896:Treatment Outcome
D001672:Biocompatible Materials; D014025:Titanium