title: Safety of cystic duct clipping in healthy and cirrhotic livers: a cadaveric study.
abstract: OBJECTIVE
  Biliary leakage through the cystic duct stump due to clip dislodgement has been a concern since the advent of the laparoscopic cholecystectomy. The authors proposed a cadaveric model to test the safety of cystic duct clipping in a hypertensive biliary tract in healthy and cirrhotic livers.
  
  
  METHODS
  Twenty fresh cadavers were studied (5 cirrhotic, 15 healthy). Open cholecystectomy was performed and the cystic duct clipped with commercially available titanium clips. The distal common bile duct was catheterized to allow infusion of water and pressure measurement.
  
  
  RESULTS
  Increased pressure in the bile duct resulted in back diffusion into the liver, preventing reaching high-pressure levels. Only 1 clip was dislodged in this situation, in a cirrhotic liver with a large cystic duct. As a second experiment, the hepatic hilum was clamped to allow higher pressures of the biliary tree (500 mm Hg). In this situation, no clip was dislodged.
  
  
  CONCLUSIONS
  We have established the safety of cystic duct clipping in healthy and cirrhotic livers; however, bigger clips or alternative methods to seal the duct may be necessary in larger ducts.
authors.affiliation: Department of Surgery, Escola Paulista de Medicina-UNIFESP São Paulo, Brazil. herbella.dcir@unifesp.epm.br
authors.forename: Fernando Augusto Mardiros
authors.initials: FA
authors.lastname: Herbella
authors.forename: Howard L
authors.initials: HL
authors.lastname: Beaton
authors.forename: Wagner
authors.initials: W
authors.lastname: Marcondes
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Del Grande
mesh_terms: D000328:Adult; D002102:Cadaver; D002763:Cholecystectomy / Q000295:instrumentation*; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments / Q000009:adverse effects*; D017792:Surgical Stapling / Q000295:instrumentation; D016896:Treatment Outcome