title: Use of stapling devices for safe cholecystectomy in acute cholecystitis.
abstract: Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.
authors.affiliation: 1 Department of Surgery, Haydarpasa Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Odabasi
authors.forename: M A Tolga
authors.initials: MA
authors.lastname: Muftuoglu
authors.forename: Erkan
authors.initials: E
authors.lastname: Ozkan
authors.forename: Cengiz
authors.initials: C
authors.lastname: Eris
authors.forename: Mehmet Kamil
authors.initials: MK
authors.lastname: Yildiz
authors.forename: Emre
authors.initials: E
authors.lastname: Gunay
authors.forename: Haci Hasan
authors.initials: HH
authors.lastname: Abuoglu
authors.forename: Kemal
authors.initials: K
authors.lastname: Tekesin
authors.forename: Sami
authors.initials: S
authors.lastname: Akbulut
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000295:instrumentation*; D041881:Cholecystitis, Acute / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D013528:Surgical Staplers
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Acute cholecystitis; Cholecystectomy; Endo-GIA; Stapler