The difference between harmonic shear versus electrocautery in fundus-first laparoscopic cholecystectomy in acute cholecystitis: a comparative study

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Abstract

Backgrounds
Laparoscopic cholecystectomy (LC) may be complicated by biliary duct injury in acute cholecystitis. In this study, we compared conventional electrocautery with the harmonic scalpel in patients undergoing LC for acute cholecystitis.
Patients and methods
The current study was carried out as a comparative study among 148 patients with acute calculary cholecystitis who were presented to the Surgery Department in the Suez Canal University Hospitals, Ain Shams University Hospitals, and Saudi German Hospital, Jeddah. The studied patients were recruited into two groups; both were subjected to LC within the first 5 days of the attack. A total of 69 patients were allocated to fundus-first LC with a harmonic scalpel, whereas 79 were recruited to fundus-first LC using electrocautery.
Results
Concerning intraoperative characteristics, the operation lasted an average of 51±5 min and 63±6 min for the harmonic scalpel and electrocautery, respectively (0.001). Blood loss, gall bladder perforation, and hospital stay were significantly lower in the harmonic scalpel group compared with the electrocautery group. Operation conversion was applied in 12.7% of the patients in the electrocautery group, compared with 4.3% in the harmonic scalpel group (<0.001). Pain reporting at 12, 24, and 36 h was significantly lower in patients who underwent harmonic scalpels. The incidence of overall morbidity was significantly higher in the electrocautery group (15 vs. 5%, <0.001).
Conclusion
The findings showed that the harmonic scalpel is a safe, feasible, and promising technique and is associated with less intraoperative and postoperative morbidities.

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