title: Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection.
abstract: BACKGROUND
  Ultrasonically activated devices have been used for gallbladder dissection in laparoscopic cholecystectomy (LC) with encouraging results. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic shears to that performed by the conventional diathermy in patients with cirrhosis.
  
  
  METHODS
  In this prospective randomized study, 40 cirrhotic Child-Pugh's classes A and B patients with symptomatic uncomplicated gallstones disease were randomly assigned to either the Harmonic scalpel LC group (20 patients) or the conventional diathermy LC group (20 patients).
  
  
  RESULTS
  The use of the harmonic shears was associated with a statistically significant shorter median operative time (55 vs. 82.5 minutes, P = .000), less median estimated intraoperative blood loss (50 vs. 120 mL, P = .000), and lower incidence of gallbladder perforation (10% vs. 70%, P = .000). In the Harmonic scalpel LC group, Laparoscopic subtotal cholecystectomy was resorted to in eight patients (40%) compared with six patients (30%) in the conventional diathermy LC group. No statistically significant difference was found between both groups as regards the conversion rate, the median hospital stay, and the incidence of postoperative complications. Neither bile leaks nor Bile duct injuries were encountered in either group. Similarly, no mortalities were encountered in the present study.
  
  
  CONCLUSIONS
  The Harmonic shears achieved complete hemobiliary stasis. Further, it provided a superior alternative to the conventional diathermy in terms of shorter operative time, less intraoperative blood loss, and lower incidence of gallbladder perforation partly through facilitating the performance of laparoscopic subtotal cholecystectomy.
authors.affiliation: Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. samerbessa@gmail.com
authors.forename: Samer S
authors.initials: SS
authors.lastname: Bessa
authors.forename: Alaa H
authors.initials: AH
authors.lastname: Abdel-Razek
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Sharaan
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Bassiouni
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: El-Khishen
authors.forename: El-Saed A
authors.initials: el-SA
authors.lastname: El-Kayal
mesh_terms: D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D003972:Diathermy; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome