Introduction: Endo GIA stapler use is a method to ligate cystic
ducts during laparoscopic cholecystectomy in the elective and
emergent setting. Its use has not been widely described in the
acute care surgery (ACS) setting. Our study aims to determine
factors predicting Endo GIA use by acute care surgeons and
evaluate when applied its safety and efficacy in emergent
cholecystectomy. Additionally, we investigate the use of
Endo GIA stapler with respect to conversion to open surgery,
reduction in postoperative morbidity, and impact on length of
stay in an ACS setting.
Materials and methods: A retrospective chart review was
conducted for laparoscopic cholecystectomy performed by ACS
in a public university training hospital over 1 year. Variables
associated with Endo GIA stapler use were identified through
multivariate logistic regression and subsequently, assessed
after optimizing the model to control for confounding effects.
Results: Of the 118 laparoscopic cholecystectomies performed,
the Endo GIA Stapler was used for cystic duct ligation in 20 cases.
Surgeons’ dictated reason for stapler use included dilated
cystic duct (45%), short cystic duct remnant (15%), inadequate
room for clip ligation and division (10%), and nonspecific (45%).
Patient demographic variables for Endo GIA stapled and clipped
groups were not significantly different. Logistic regression
revealed a significantly higher likelihood of Endo GIA stapler
use in patients with comorbid biliary duct disease, preoperative
endoscopic retrograde cholangiopancreatography (ERCP), and
a trend towards significance in patients with previous emergency
department (ED) visits. There was no significant difference
in conversion to open surgery, postoperative morbidity, and
postoperative length of stay.
Conclusion: Comorbid biliary duct disease, previous ED visits,
and preoperative ERCP are predictive of patients requiring use
of the Endo GIA stapler for cystic duct ligation during emergent
cholecystectomy. The use of Endo GIA stapler by Acute Care
Surgeons is safe and effective.
Keywords: Acute care surgery, Acute cholecystitis, Cystic
duct ligation, Emergent cholecystectomy, Emergency general
surgery, Laparoscopic stapler, Panamerican trauma society.
How to cite this article: Truche P, Blitzer D, Scott E, Hanna J,
Gracias V, Peck G. Acute Care Surgeon: Use of the Endo GIA
Stapler for Cystic Duct Ligation in Emergent Cholecystectomy.
Panam J Trauma Crit Care Emerg Surg 2017;6(1):44-48.
Source of support: Nil
Conflict of interest: None