Control of cystic artery in Laparoscopic Cholecystectomy: To clip or to use monopolar electrocautery

Objective: The purpose of this study was to compare monopolar electrocautery with clip application for securing hemostasis of cystic artery in patients undergoing laparoscopic cholecystectomy. Methodology: A comparative study was performed on data collected during a 6-years period (2005-2011) from 600 patients who underwent laparoscopic cholecystectomy. In 306 cases assigned to group 1, the cystic artery was clipped while in 294 cases assigned to group 2, the cystic artery was coagulated with monopolar electrocautery. Results: In group 1, the cystic artery was single in 91%, branched in 6% and absent in 3% cases while in group 2, the cystic artery was single in all cases. The cystic artery was of normal size in 82%, short in 7%, tong in 8% and absent in 3% cases in group 1 while in group 2, it was normal in size in 88%, short in 3% and long in 9% cases. The cystic artery was originating from the right hepatic artery in 97% cases and from the superior mesenteric artery in 3% cases in group 1. In group 2, the cystic artery was originating from the right hepatic artery in 97% cases and not visualized in 3% cases. In group 1, only 3 patients had an intra-operative hemorrhage while in group 2, 3 of the patients had bleeding. The post operative recovery was also similar in both groups with 83% and 81% patients going home on the next day. Conclusions: There was no difference in the outcome of patients whether clips or monopolar electrocautery was used for hemostasis of cystic artery in laparoscopic cholecystectomy.