Effect of Electrocoagulation and Direct Pressure Application on Bleeding from Liver Bed During Laparoscopic Cholecystectomy.

Abstract

Objective: To compare the efficacy of electrocoagulation and direct pressure application in controlling haemorrhage from the liver bed during laparoscopic cholecystectomy.

Study design: Randomized controlled trial. Place and Duration of the Study: Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Pakistan, from July 2021 to December 2021.

Methodology: A total of 218 patients of either gender, aged 18 to 60 years and with bleeding from the liver bed during laparoscopic cholecystectomy were randomly allocated to two groups of haemorrhage control techniques. In group A, electrocoagulation was used and in group B, direct pressure was applied to the bleeding area for 5 minutes. Efficacy in controlling bleeding was compared in both groups.

Results: The mean age of all study participants was 44.6 + 13.5 years. The majority of the patients were females (89%). The mean body mass index (BMI) of all participants was 25.3 ± 3.09 kg/m2. Intraoperative bleeding was secured in 86.2% of patients in Group A vs. 81.7% of patients in Group B. However, the difference was not statistically significant (p=0.356). In 27 (12.4%) cases, bleeding could not be controlled by both of these techniques. In these cases, endosuturing was applied in 19 (70.4%) cases, spongostan in 6 (22.2%) cases, and endo-clips in 2 (7.4%) cases. Intraoperative drain and conversion to open procedure was required in 1 patient each, both belonging to the direct pressure application group.

Conclusion: The efficacy of electrocoagulation in securing haemorrhage from the liver bed is better than the direct pressure application technique.

Key words: Laparoscopic cholecystectomy, Haemorrhage, Electrocoagulation, Surgical hemostasis, Liver bed.