Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Sci Rep. 2024 Oct 23;14(1):25062. doi: 10.1038/s41598-024-75398-x.
This research explores the challenges posed by variations in cystic duct anatomy during laparoscopic cholecystectomy and the potential use of stapler devices to address such complexities. It aims to assess the safety and efficacy of stapler devices, particularly in cases involving short, and wide cystic duct. The study, conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2021 and 2023. The study design involved a retrospective cohort approach, and the sample size encompassed all cases meeting the inclusion criteria during the study period. Data was analyzed using SPSS program. The study involving 568 patients, with the predominant technique for ligation being clipping (89.3%). The primary indication for using the Endo GIA stapler was a wide cystic duct (6.2%). Analysis revealed a significant association between stapler device use and hypertension (p = 0.042), diabetes (p = 0.001), CKD (p = 0.011), and obstructive jaundice (p = 0.006). Multivariate regression demonstrated that older patients were 2.1 times more likely to use stapler devices (AOR = 2.125; p = 0.039), while those with obstructive jaundice had a 2.2 times higher likelihood (AOR = 2.168; p = 0.049). Throughout the years, metal clips have shown the best prognosis compared to any other method for securing the cystic duct during closure in laparoscopic cholecystectomy. However, to avoid incomplete sealing of wide, short, or inflamed ducts, other instruments have emerged as possible alternatives for such conditions. Use of Endo-GIA is a safe and effective method for patients with wide, short cystic duct. Selective usage of endo-GIA is considered cost effective and may add a positive impact in decreasing post operative biliary leak.
本研究探讨了腹腔镜胆囊切除术中胆囊管解剖变异带来的挑战，以及使用吻合器设备解决这些复杂性的潜力。旨在评估吻合器设备的安全性和有效性，特别是在涉及短而宽的胆囊管的情况下。该研究在沙特阿拉伯利雅得的阿卜杜勒阿齐兹国王医疗城进行，时间为 2021 年至 2023 年。研究设计采用回顾性队列方法，样本量包括研究期间符合纳入标准的所有病例。使用 SPSS 程序进行数据分析。该研究共涉及 568 例患者，结扎的主要技术是夹闭（89.3%）。使用 Endo GIA 吻合器的主要指征是胆囊管较宽（6.2%）。分析显示，吻合器设备的使用与高血压（p=0.042）、糖尿病（p=0.001）、CKD（p=0.011）和阻塞性黄疸（p=0.006）显著相关。多变量回归表明，老年患者使用吻合器的可能性是年轻患者的 2.1 倍（AOR=2.125；p=0.039），而阻塞性黄疸患者的可能性则高出 2.2 倍（AOR=2.168；p=0.049）。多年来，与腹腔镜胆囊切除术中闭合胆囊管的任何其他方法相比，金属夹显示出最佳的预后。然而，为了避免不完全密封宽、短或发炎的胆管，对于这些情况出现了其他仪器作为可能的替代方法。对于宽、短胆囊管的患者，使用 Endo-GIA 是一种安全有效的方法。选择性使用 Endo-GIA 被认为具有成本效益，并可能在减少术后胆漏方面产生积极影响。
