Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

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: 01-10-2014

Copyright Statement:  Copyright © 2017; The Author(s).


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.


HTML PDF Share
  1. NIH Consens Statement 1992 Sep;10(3):1-28.
  2. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015 May;400(4):429-453.
  3. Time and cost analysis of gallbladder surgery under the acute care surgery model. J Trauma Acute Care Surg 2014 Mar;76(3):710-714.
  4. Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg 2012 Nov;215(5):715-721.
  5. An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis. Am Surg 2011 Oct;77(10):1318-1321.
  6. The acute surgical unit model verses the traditional “on call” model: a systematic review and meta-analysis. World J Surg 2014 Jun;38(6):1381-1387.
  7. Laparoscopic subtotal cholecystectomy: a review of 56 procedures. J Laparoendosc Adv Surg Tech A 2000 Feb;10(1):31-34.
  8. A novel ligation forceps can be used as a ligature carrier and knot pusher during laparoscopic surgery. Surg Endosc 2001 May;15(5):524-527.
  9. Ligating the cystic duct in laparoscopic cholecystectomy. Am J Surg 2000 Jun;179(6):494-496.
  10. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 2008 Aug;18(4):593-598.
  11. New technique to ligate enlarged cystic duct using a clip applier during laparoscopy: report of a case. Hepatogastroenterology 2002 Jul-Aug;49(46):926-927.
  12. Absorbable clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Endosc 1996 Jan;10(1):49-51.
  13. Overlapped-clipping, a new technique for ligation of a wide cystic duct in laparoscopic cholecystectomy. Hepatogastroenterology 2005 Jul-Aug;52(64):1039-1041.
  14. Pitfalls in the use of laparoscopic staplers to perform subtotal cholecystectomy. BMJ Case Rep 2013 Apr;2013.
  15. Application of an endo-GIA for ligation of the cystic duct during difficult laparoscopic cholecystectomy. Hepatogastroenterology 2011 Mar-Apr;58(106):285-289.
  16. Use of stapling devices for safe cholecystectomy in acute cholecystitis. Int Surg 2014 Sep-Oct;99(5):571-576.
  17. Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol 2007 Mar;41(3):301-305.
  18. Diagnosis and management of bile leaks following laparoscopic cholecystectomy. Surg Laparosc Endosc 1994 Jun;4(3):163-170.
  19. Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases. J Gastrointest Surg 2010 Apr;14(4):688-696.
  20. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 2015 Jun;18:196-204.
  21. The dangers of using stapling devices for cystic duct closure in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2009 Oct;19(5):e194-e197.
  22. Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc 2003 Mar;17(3):442-451.
  23. Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 2001 Sep;67(9):901-906.
  24. Laparoscopic cholecystectomy performed by acute care surgeons and general surgeons. Am Surg 2015 May;81(5):E220-E221.
  25. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci 2014 Dec;18(2 Suppl):40-46.
  26. Endo-GIA for ligation of dilated cystic duct during laparoscopic cholecystectomy: an alternative, novel, and easy method. J Laparoendosc Adv Surg Tech A 2004 Jun;14(3):153-157.
  27. Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis. BMC Gastroenterol 2015 Oct;15:142.
  28. Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study. Kaohsiung J Med Sci 2014 Sep;30(9):459-465.
  29. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013 Jan;20(1):24-34.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.