Comparison of Single Clip Laparoscopic Cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC): A Randomized Control Study

Background: Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing and avoiding the use of a larger number of titanium clips. This study was undertaken to compare the advantages of Single clip laparoscopic cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC). Materials and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st July 2019 to 30th June 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent SCLC and Group 2 patients underwent TCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used, post-operative pain, conversion into open cholecystectomy and post-operative complications. Results: Among the total 100 patients, 24 were males and 76 were females. Among them, 10 males and 40 females underwent single Clip Laparoscopic Cholecystectomy (SCLC) while 14 males and 36 females underwent Two Clips Laparoscopic Cholecystectomy (TCLC). Mean age of males were 48.50±14.49 and females were 46.73±16.16 in SCLC group while mean age of males were 45.36±14.53 and females were 45.25±15.97 in two clips laparoscopic cholecystectomy group. Present study showed that there was more Operative Time, more Mean CO2 used, more Approx. Blood Loss, more Intra Op. Stone spillage and more Use of Drain but less Average pain score at 6 and 24 hours and less Average Length of hospital stay in DCLC group as compared to SCLC group but this difference was not statistically significant. Similarly in both group equal number of patients Convered to Open Cholecystectomy and there was no Post op. Complications in both groups. Conclusion: Study concluded that there was no statistically significant difference among both SCLC and DCLC groups in terms of operative time, intra operative stone spillage, Use of Drain, intra operative blood loss, amount of CO2 used, post-operative pain, Conversion to Open Cholecystectomy and post-operative complications.