Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 1 ( January-April, 2017 ) > List of Articles

REVIEW ARTICLE

Acute Care Surgeon: Use of the Endo GIA Stapler for Cystic Duct Ligation in Emergent Cholecystectomy

Vicente Gracias, Paul Truche, David Blitzer, Erin Scott, Joseph Hanna

Citation Information : Gracias V, Truche P, Blitzer D, Scott E, Hanna J. Acute Care Surgeon: Use of the Endo GIA Stapler for Cystic Duct Ligation in Emergent Cholecystectomy. Panam J Trauma Crit Care Emerg Surg 2017; 6 (1):44-48.

DOI: 10.5005/jp-journals-10030-1171

License: CC BY 3.0

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Endo GIA stapler use is a method to ligate cystic ducts during laparoscopic cholecystectomy in the elective and emergent setting. Its use has not been widely described in the acute care surgery (ACS) setting. Our study aims to determine factors predicting Endo GIA use by acute care surgeons and evaluate when applied its safety and efficacy in emergent cholecystectomy. Additionally, we investigate the use of Endo GIA stapler with respect to conversion to open surgery, reduction in postoperative morbidity, and impact on length of stay in an ACS setting.

Materials and methods

A retrospective chart review was conducted for laparoscopic cholecystectomy performed by ACS in a public university training hospital over 1 year. Variables associated with Endo GIA stapler use were identified through multivariate logistic regression and subsequently, assessed after optimizing the model to control for confounding effects.

Results

Of the 118 laparoscopic cholecystectomies performed, the Endo GIA Stapler was used for cystic duct ligation in 20 cases. Surgeons’ dictated reason for stapler use included dilated cystic duct (45%), short cystic duct remnant (15%), inadequate room for clip ligation and division (10%), and nonspecific (45%). Patient demographic variables for Endo GIA stapled and clipped groups were not significantly different. Logistic regression revealed a significantly higher likelihood of Endo GIA stapler use in patients with comorbid biliary duct disease, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and a trend towards significance in patients with previous emergency department (ED) visits. There was no significant difference in conversion to open surgery, postoperative morbidity, and postoperative length of stay.

Conclusion

Comorbid biliary duct disease, previous ED visits, and preoperative ERCP are predictive of patients requiring use of the Endo GIA stapler for cystic duct ligation during emergent cholecystectomy. The use of Endo GIA stapler by Acute Care Surgeons is safe and effective.

How to cite this article

Truche P, Blitzer D, Scott E, Hanna J, Gracias V, Peck G. Acute Care Surgeon: Use of the Endo GIA Stapler for Cystic Duct Ligation in Emergent Cholecystectomy. Panam J Trauma Crit Care Emerg Surg 2017;6(1):44-48.

Introducción

El uso de la engrapadora EndoGIA para ligar el conducto cístico es un método utilizado durante Colecistectomías laparoscópicas en situaciones electivas y emergentes. El uso de este método no ha sido descrito de una manera extensiva en el campo de Cirugía de Cuidados Agudos (ACS). Las metas de nuestro estudio son el poder determinar los diferentes factores que podrían predecir el uso de la engrapadora EndoGIA para el uso de Cirujanos de Cuidados Agudos y poder evaluar la eficacia y seguridad que provee durante una Colecistectomía emergente. Adicionalmente, investigamos el uso de la engrapadora EndoGIA considerando la conversión a cirugía abierta, reducir la morbosidad post-operativa, y el impacto de el tiempo de estadía en un establecimiento de cuidados agudos (ACS).

Materiales y métodos

Se hizo una revisión retrospectiva de documentos médicos de Colecistectomías laparoscópicas en una situación emergente (ACS) hechas en una Universidad/Hospital publico de medicina durante un año. Los variables asociados con el uso de la engrapadora EndoGIA fueron identificados atreves de un estudio de Regresión logística multivariante y fue juzgado después de mejorar el modelo para controlar los efectos de confusión.

Resultados

De las 118 Colecistectomía laparoscópicas hechas, la engrapadora EndoGIA fue utilizada para ligaciones de conducto cístico en 20 casos. Los cirujanos tomaron la decisión de el uso de la engrapadora EndoGIA en las siguientes situaciones: Un Conducto Cístico Dilatado (45%), restos de conducto cístico cortos (15%), un espacio inadecuado para poder ligar con clips & el poder dividir (10%), y descripciones no especificas (45%). Los variables demográficos de los pacientes que fueron tratados con la engrapadora EndoGIA o con clips no fueron significantemente diferentes. El estudio de Regresión Logística demostró que hay una mayor probabilidad de el uso de la Engrapadora EndoGIA en pacientes que tienen una comorbilidad de enfermedad de conducto cístico, CPRE “Colangiopancreatografia Retrograda Endoscópica” Pre-Operativa, y una tendencia en pacientes con visitas previas a la sala de emergencia. No se encontró una diferencia significante en conversiones a cirugía abierta, morbosidad post-operativa, y el tiempo de estadía en un establecimiento de cuidados agudos (ACS).

Conclusión

Comorbilidad de enfermedad de conducto cístico, visitas previas a la sala de emergencia, y CPRE “Colangiopancreatografia Retrograda Endoscópica” Pre-Operativa, son situaciones que predicen el uso de la engrapadora EndoGIA en pacientes para la ligación de conducto cístico durante una Colecistectomía emergente. El uso de la engrapadora EndoGIA por Cirujanos de Cuidados Agudos es un método seguro y efectivo.


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