title: Clipless laparoscopic cholecystectomy using the Harmonic scalpel for cirrhotic patients: a prospective randomized study.
abstract: BACKGROUND
  Improved laparoscopic experiences have made laparoscopic cholecystectomy (LC) feasible options for cirrhotic patients. This study aimed to compare the traditional method for LC with LC using the Harmonic scalpel in terms of safety and efficacy for cirrhotic patients.
  
  
  METHODS
  In this study, group A (60 patients) underwent LC by the traditional method (TM) with clipping of both the cystic duct and artery and dissection of the gallbladder by diathermy, and group B (60 patients) had LC performed using Harmonic scalpel (HS) closure and division of both the cystic duct and artery with dissection of the gallbladder by the HS. The perioperative data were recorded.
  
  
  RESULTS
  The operation with the Harmonic scalpel was performed in less time than TM (45.17 ± 10.54 vs. 69.71 ± 13.01 min; p = 0.0001). The intraoperative blood loss was significantly more with TM (133 ± 131.13 l vs. 70.13 ± 80.79 ml; p = 0.002). The conversion rate was 5% with TM and 3.3% with HS (p = 0.65). The incidence of gallbladder peroration was lower in the HS group (10% vs. 18.3%; p = 0.03). Bile leak was encountered in 1.7% with HS and 3.3% with TM (p = 0.45). The visual analog scale (VAS) for pain with HS on postoperative day 1 was (3.07 ± 2.02 vs. 4.4 ± 2.11 (p = 0.001).
  
  
  CONCLUSIONS
  For cirrhotic patients, LC still is more complicated and difficult than for patients without cirrhosis. The Harmonic scalpel provides complete hemobiliary stasis and is a safe alternative to the standard clipping of the cystic duct and artery for cirrhotic patients. It offers a shorter operative duration and less blood loss.
authors.affiliation: Department of General Surgery, Mansoura University, Mansoura, Egypt. elnakeebayman@yahoo.com
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Waleed
authors.initials: W
authors.lastname: Askar
authors.forename: Ramadan
authors.initials: R
authors.lastname: El Lithy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013525:Surgical Instruments; D014464:Ultrasonic Therapy / Q000295:instrumentation*; D055815:Young Adult