Intracorporeal vicryl ligatures reduces cost in some countries.
BACKGROUND
Financial constraints and pressing priorities are major problems that delay implementation of laparoscopic cholecystectomy (LC) in some countries. This raised the need for improvisation and innovation. Endoclips are not available in some local markets. They cost $50 for a single set of six clips to import, in contrast to 2/0 polyglacin (Vicryl-Ethicon), which is available at a rate of $1.5 for one thread.


OBJECTIVE
To compare the safety and cost between vicryl ligature and endoclips.


METHODS
To secure the cystic duct, intracorporeal vicryl ligature (IVL) was applied in 64 LCs. These were divided into 32 patients presented with cystic duct, which was too wide to controlled with endoclips (group A) and 32 patients with normal diameter of cystic duct as controls (group B). Also we describe the test we used to prove the safety of IVL in the two groups. This ligature was tested with high pressure introduced and measured into the gallbladder by sphygmomanometer.


RESULTS
The gallbladder can withstand a mean (+ SD) pressure of 197 (+20.94) mmHg and 191.67 (+10.2) in group A and B respectively without statistically significant difference (P 0.1305). Total cost of vicryl was $128 compared to $3200 if endoclips were used. No complication was noted related to these ligatures in a period of two year-follow up.


CONCLUSIONS
This method is easy, cost effective and suitable in some countries.
Department of Medicine, Ibn Sina Hospital and Liver Diseases Centre, Khartoum, Sudan. ibnouf@sudanmail.net
Ahmed Mohammed
AM
Ibn Ouf
Yahia
Y
Al Arabi