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Polymeric locking clips [Hem-o-lok] versus Metallic clips in elective Laparoscopic Cholecystectomy: A Retrospective
Shibumon Madhavan1, Anshuman Pandey1, Shakeel Masood1
1Department of Surgical Gastroenterology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, Uttar Pradesh, India.
Insights
Hem-o-lok clips are safer and more effective than metallic ligaclips for securing the cystic duct during laparoscopic cholecystectomy, especially in cases with wide or thick ducts. This leads to comparable post-operative outcomes with a lower risk of complications.
Area of Science:
- Surgical innovation
- Gastrointestinal surgery
- Minimally invasive procedures
Background:
- Laparoscopic cholecystectomy is a frequent surgical procedure.
- Various techniques exist for managing the cystic artery and duct.
- Comparative efficacy of different clip types requires investigation.
Purpose of the Study:
- To compare intra-operative and early post-operative outcomes of laparoscopic cholecystectomy.
- To evaluate the use of Hem-o-lok clips versus metallic ligaclips for securing the cystic duct and artery.
Main Methods:
- Retrospective analysis of prospectively maintained data from 2013-2018.
- Inclusion of consecutive patients undergoing elective laparoscopic cholecystectomy.
- Grouping patients based on clip type: metallic ligaclips (Group I) and Hem-o-lok clips (Group II).
Main Results:
- 1496 patients included: 836 in Group I and 660 in Group II.
- Hem-o-lok clips demonstrated superior efficacy in securing wide cystic ducts (0 failures vs. 8 failures with metallic clips, p=0.002).
- Post-operative outcomes, including leaks, bleeding, and bile duct injuries, were comparable between groups.
Conclusions:
- Hem-o-lok clips offer a safe and secure method for laparoscopic cholecystectomy.
- Their ease of application and effectiveness in managing wide or thick cystic ducts reduce leak risk.
- Both clip types yielded comparable early post-operative outcomes without major complications.
Abstract:
Background Laparoscopic cholecystectomy is one of the most commonly performed operation. Various methods for securing the cystic artery and cystic duct are described in literature. We aim to compare intra-operative and early post-operative outcomes of laparoscopic cholecystectomy using polymeric locking Hem-o-lok clips versus metallic ligaclips . Patients and Methods Retrospective study of prospectively maintained single institutional data including all consecutive patients who underwent elective laparoscopic cholecystectomy from 2013 to 2018. Patients in whom metallic ligaclips were used were grouped as Group I and those with Hem-o-Lok were grouped as Group II. The early post-operative outcomes of the two groups were compared. Results Total 1496 patients were included in the study; 836 patients in Group I and 660 in Group II. Study included 29.1% males and 70.9% females with mean age of 43.6 years. Hem-o-lok clip was better in securing wide cystic duct compared to metallic clips. Metallic clip failed to secure 8 out of 44 wide cystic duct compared to 0 out 70 with Hem-o-lok clips (p=0.002). The post-operative outcomes of both groups were comparable. There were no cystic duct leak, post- operative bleeding or major bile duct injuries in either group. Conclusion Use of Hem-o-lok clip is safe in laparoscopic cholecystectomy due to ease of application and security. Hem-o-lok is more useful in patients with thick and wide cystic duct which are difficult to secure with metallic clips with low risk of leak. Key words: Laparoscopic Cholecystectomy, Hem-o-lok clip, Metallic clip, Wide cystic duct.
