Concurrent ligation of cystic duct and cystic artery versus separate ligation during laparoscopic cholecystectomy in patients with acute cholecystitis

Introduction
Laparoscopic cholecystectomy as a gold standard for treatment of patients with acute cholecystitis is associated with complications. Some complications are dependent on the methods of surgery and applying clips.

Aim of the research
To compare complications following concurrent and separate ligation of cystic duct and artery and evaluate the costs of each procedure.

Material and methods
The study was designed as a prospective cohort. Patients with acute cholecystitis due to gallstones were included. They were assigned into two groups: 1) separate ligation group and 2) concurrent ligation group. Routine laparoscopic surgery was performed. For the first group, the hilum was dissected and the cystic duct and artery were ligated separately. For the concurrent group, the cystic duct and artery were ligated together. Intra-operative and post-operative data were measured.

Results
A total of 122 patients were enrolled in this study. The median lengths of symptoms to surgery were 3.23 days for the concurrent group versus 3.67 days for the separate group (p = 0.004). There was no statistically significant difference in post-operative complications. One patient in the concurrent group had biliary colic and cholestasis due to a stone in common bile duct managed by endoscopic retrograde cholangiopancreatography. Twice as many clips were used in the separate group than in the concurrent group (six clips vs. three clips, p ≤ 0.001). Further analyses revealed that operation time and costs were significantly higher in the separate ligation group.

Conclusions
The mean duration of surgery and number of clips applied for ligation were higher in the separate ligation group. Concurrent ligation seems to be associated with similar complications and therapeutic outcomes compared to separate ligation and is cost effective for replacement of the routine procedure in the future.