Use of Linear Endostaplers for the Cystic Duct Closure in Laparoscopic Cholecystectomy

The laparoscopic approach has been the treatment of choice for cholecystectomy since 1987.However, in some cases (dilated cystic duct, >1cm, fibrous, edematous, or inflamed), the traditional technique of closing the cystic duct with metal endoclips may not be an appropriate approach, as complications such as biliary leakage or obstructive jaundice due to the formation of stones in the common bile duct from clip migration may occur, among others.In these circumstances, the use of linear endostaplers for the cystic duct has been proposed as a safe, quick, and feasible method with low morbidity associated with performing laparoscopic cholecystectomy.The objective of this study is to assess the use of linear mechanical suture devices in the surgical treatment of complex laparoscopic cholecystectomies, which can be considered an effective technique in these cases of "difficult" cystic ducts.To achieve this, we conducted a retrospective cohort study, analyzing all patients who underwent laparoscopic cholecystectomy by the General Surgery Department of the Hospital Universitario de Canarias between 01/01/2012 and 12/31/2015, comparing the usual sealing with endoclips and the use of endostaplers, and analyzing possible differences in complications.We conclude that the use of mechanical suture devices in approaching gallbladder pathology when the cystic duct is dilated or its handling is very laborious is a safe and reliable way to treat this pathology.Its use does not result in a higher number of complications in closing the cystic duct compared to the standard endoclip technique.