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Review
. 2022 Dec 8;14(12):e32335.
doi: 10.7759/cureus.32335. eCollection 2022 Dec.

Harmonic Scalpel Versus Clips for Ligation of Cystic Duct in Laparoscopic Cholecystectomy: A Systematic Review

Chirag Pereira  1 , Shankar Gururaj  2 , Benji Varghese  3
Affiliations
Review

Harmonic Scalpel Versus Clips for Ligation of Cystic Duct in Laparoscopic Cholecystectomy: A Systematic Review

Chirag Pereira et al. Cureus. .

Abstract

The gold standard treatment for benign gallbladder disease is laparoscopic cholecystectomy (LC). LC is commonly performed using monopolar diathermy with ligation of the cystic duct and artery with clips. The aim of the current systematic review was to compare harmonic scalpel (HS) with clips in LC. Eligible studies were identified from PubMed, Cochrane library, Embase and Medline and meta-analysis was conducted using Review Manager 5.4. The primary outcome evaluated was bile leak while secondary outcomes evaluated were overall postoperative complications, operative time, conversion to open surgery and gall bladder perforation. Eight randomized control trials met the eligibility criteria which included a total of 1,205 patients. There was no statistically significant difference between the two groups in terms of bile leak (p = 0.56, I2=0%). With respect to the operative time (p = 0.004, I2=97%), conversion to open surgery (p = 0.02, I2=0%) and gall bladder perforation (p = 0.0001, I2=26%) HS was superior to clips. HS is an acceptable alternative to the use of clips when ligating the cystic duct.

Keywords: bile leak; clips; conventional laparoscopic cholecystectomy; harmonic scalpel; systematic review.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow chart
Preferred Reporting Items for Systemic Reviews and Meta-Analyses
Figure 2
Figure 2. Risk of Bias among included studies
Figure 3
Figure 3. Comparison of age between harmonic group and clips group
Figure 4
Figure 4. Comparison of bile leak between harmonic group and clips group
Figure 5
Figure 5. Comparison of operative time between harmonic group and clips group
Figure 6
Figure 6. Comparison of conversion to open surgery between harmonic group and clips group
Figure 7
Figure 7. Comparison of gall bladder perforation between harmonic group and clips group
Figure 8
Figure 8. Comparison of operative complications between harmonic group and clips group.
See this image and copyright information in PMC

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