Page 591 - Best practice_Oral2024 (อัพเดต)

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การศึกษาผลของการใช้ไหมผูกท่อถุงน้ำดี (Duncan loop) เปรียบเทียบกับการใช้คลิป

พลาสติกผูกท่อถุงน้ำดี (Hem-o-lok) ในการผ่าตัดถุงน้ำดีผ่านกล้องวิดีทัศน์

นายแพทย์อรรณพ วิเศษชู
โรงพยาบาลพหลพลพยุหเสนา จังหวัดกาญจนบุรี เขตสุขภาพที่ 5
ประเภท วิชาการ

Duncan loop versus Hem-o-lok clip ligation of cystic duct in laparoscopic
cholecystectomy
ANNOP WISETCHU M.D.

Department of Surgery, Phaholpolpayuhasena Hospital, Office of the Permanent Secretary
Ministry of Public Health, Kanchanaburi, Thailand

Abstract
Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for
symptomatic gallstones. Many complications may arise due to the failure of the cystic duct ligation.

Wecompare the patient outcomes of cystic duct ligation by Duncan loop versus Hem-o-lok
clip.
Materials and Methods: This retrospective studyreviewed the outcome of 800 patients

with extra-corporally ligated by Duncan loop and 662 patients with cystic duct secured by Hem-o-
lok clip.We collected data from 1st October 2017 to 30th September 2023. In
Phaholpolpayuhasena Hospital Kanchanaburi,Thailand.Characteristics analyzed were age, sex,
BMI, disease of gallbladder, type of cystic duct ligation, operative time, blood loss, length of
stay (LOS), hospital cost, and complications. The differences between the groups were

compared using a t-test and chi-square.
Results: In the Duncan loop group, the mean age was 53.04 years and the average BMI
was 25.89. 530 patients (66.20%) of the participants were female. On the other hand, chronic

cholecystitis (49.80%) is the most common indication for surgery. The average operative time
was 56.39 minutes. The mean estimated blood loss was 39.59 ml. The median LOS was 3.24
days. The average hospital cost was 22,921.54 Bath. 3 patients had complications with bile
duct injury and 2 patients had bile leakage.Whereas in the Hem-o-lok clip group, the mean age

was 50.95 years and the average BMI was 26.07. Similarly, there were more female patients,
which is 485 patients (73.30%). Unlike the other group, the most common indication was
symptomatic gallstone (68.30%). The average operative time was 71.40 minutes. The mean
estimated blood loss was 24.76 ml. The median LOS was 3.37 days. The average hospital cost

was 24,322.55 Bath. 2 patients had complications with bile duct injury, 3 patients had bile leakage
and 1 patient had an intra-abdominal collection. In comparison, there was no difference in
complication and LOS. Although the estimated blood loss was higher in the Duncan loop
group, operative time was lesser and the cost was cheaper.