Comparing the Effect of Electrocoagulation and Direct Pressure Application with Adrenaline-Soaked Gauze on Bleeding from Liver Bed during Laparoscopic Cholecystectomy

Muhammad Sohail; Mehmood Ayyaz; Falak Sher; Bushra Liquat

doi:10.54112/bcsrj.v6i9.2314

Authors

Muhammad Sohail Department of General Surgery, National Hospital & Medical Center, Lahore, Pakistan
Mehmood Ayyaz Department of General Surgery, National Hospital & Medical Center, Lahore, Pakistan
Falak Sher Department of General Surgery, Shahdra Teaching Hospital, Lahore, Pakistan
Bushra Liquat Department of General Surgery, National Hospital & Medical Center, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i9.2314

Keywords:

Laparoscopic cholecystectomy, Electrocoagulation, Adrenaline gauze, Hemostasis

Abstract

Liver bed bleeding during laparoscopic cholecystectomy may prolong operative time and increase the need for additional hemostatic measures. Electrocoagulation and adrenaline-soaked gauze pressure are commonly used methods, but comparative evidence remains limited. Objective: To compare the effectiveness of electrocoagulation and direct pressure application with adrenaline-soaked gauze for achieving hemostasis from the liver bed during laparoscopic cholecystectomy. Methods: This randomized controlled trial was conducted at the Department of General Surgery, National Hospital & Medical Centre, Lahore, from 5 May 2025 to 5 August 2025. A total of 150 patients aged 20–60 years undergoing elective laparoscopic cholecystectomy were randomized into two equal groups. Group A underwent electrocoagulation of the liver bed, while Group B received direct pressure using adrenaline-soaked gauze for five minutes. The primary outcome was secured hemostasis, while secondary outcomes included time to hemostasis, blood loss, operative time, need for additional hemostatic measures, and length of hospital stay. Categorical variables were compared using the chi-square test, while continuous variables were analyzed using the independent-samples t-test. A p-value ≤0.05 was considered statistically significant. Results: Secured hemostasis was achieved in 72 (96.0%) patients in the electrocoagulation group compared to 61 (81.3%) in the adrenaline gauze group (p=0.006). Mean time to hemostasis was significantly shorter in Group A (3.1 ± 1.2 minutes) than in Group B (5.4 ± 1.8 minutes; p<0.001). Mean blood loss (58 ± 22 vs. 98 ± 35 mL; p<0.001) and operative time (46.2 ± 8.5 vs. 54.7 ± 11.2 minutes; p<0.001) were also lower with electrocoagulation. Additionally, hemostatic measures were required less frequently in Group A (4.0% vs. 18.7%; p=0.004). Length of hospital stay was shorter in the electrocoagulation group (1.6 ± 0.7 vs. 2.8 ± 1.4 days; p<0.001). Conclusion: Electrocoagulation provides faster and more reliable hemostasis with reduced blood loss and shorter operative duration compared with adrenaline-soaked gauze, and may be considered the preferred method for liver bed bleeding control during laparoscopic cholecystectomy.

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References

1. Ng A, Wang N, Tran M. Minimally invasive surgery: early concepts to gold standards. *Br J Hosp Med (Lond).* 2019;80(9):494-495. DOI: https://doi.org/10.12968/hmed.2019.80.9.494

2. Berci G, Greene FL. Laparoscopic cholecystectomies. In: *No Stones Left Unturned: Hans Kehr and His Contributions to Biliary Surgery from Inception to Worldwide Application in the Modern Era of Laparoscopic Surgery.* Cham: Springer; 2021. p. 79-84. DOI: https://doi.org/10.1007/978-3-030-76845-4_13

3. Chattopadhyay K, Das R. Laparoscopic and open cholecystectomy: a comparative study. *Int J Surg Sci.* 2020;4(1):427-430. DOI: https://doi.org/10.33545/surgery.2020.v4.i1h.375

4. Agarwal S, Joshi AD. Perioperative complications of laparoscopic cholecystectomy: a cross-sectional observational study. *Int Surg J.* 2020;7(5):1490-1495. DOI: https://doi.org/10.18203/2349-2902.isj20201857

5. Saleh KAK. Study of complications of laparoscopic cholecystectomy. *Univ Aden J Nat Appl Sci.* 2018;22(1):189-194. DOI: https://doi.org/10.47372/uajnas.2018.n1.a16

6. Park J, Koh J. Era of bloodless surgery: spotlights on hemostatic materials and techniques. *Hanyang Med Rev.* 2018;38(1):3-15. DOI: https://doi.org/10.7599/hmr.2018.38.1.3

7. Rajnish K, Sureshkumar S, Ali MS, Vijayakumar C, Sudharsanan S, Palanivel C. Harmonic scalpel-assisted laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a non-randomized control trial. *Cureus.* 2018;10(1). DOI: https://doi.org/10.7759/cureus.2084

8. Kannan A, Tara A, Quadir H, Hakobyan K, Gaddam M, Ojinnaka U, et al. The outcomes of the patients undergoing harmonic scalpel laparoscopic cholecystectomy. *Cureus.* 2021;13(6). DOI: https://doi.org/10.7759/cureus.15622

9. Ahmad DS, Faulx A. Management of postcholecystectomy biliary complications: a narrative review. *Am J Gastroenterol.* 2020;115(8):1191-1198. DOI: https://doi.org/10.14309/ajg.0000000000000704

10. Yusoff AR, Lomanto D. Hemostasis in laparoscopic surgery. In: Lomanto D, Chen WTL, Fuentes MB, editors. *Mastering Endo-Laparoscopic and Thoracoscopic Surgery.* Singapore: Springer; 2023. p. 39-44. DOI: https://doi.org/10.1007/978-981-19-3755-2_7

11. Dammann K, Gifford A, Kelley K, Stawicki SP. Operative hemostasis in trauma and acute care surgery: the role of biosurgical agents. In: Firstenberg MS, Stawicki SP, editors. *Contemporary Applications of Biologic Hemostatic Agents across Surgical Specialties.* London: IntechOpen; 2020. DOI: https://doi.org/10.5772/intechopen.94100

12. Mukhtar Z, Masood HMU, Akbar A, Gondal KM, Afzal A, Naveed M. Comparison of direct pressure versus electrocauterization of liver bed for bleeding control in laparoscopic cholecystectomy. *Ann King Edw Med Univ.* 2021;27(2):194-198. DOI: https://doi.org/10.21649/akemu.v27i2.4534

13. Aslam RD, Liew J, Besi E. Is 1:1000 adrenaline as a topical haemostat an effective alternative to control bleeding in dentistry and oral surgery? *Br Dent J.* 2023;235(1):29-34. DOI: https://doi.org/10.1038/s41415-023-6010-7

14. Omura K, Hosokawa Y, Nomura K, Aoki S, Tochigi K, Miyashita K, et al. Effect of gauze placement soaked with adrenaline at suprabullar recess on hemostasis during endoscopic sinus surgery: a randomized controlled trial. *Head Neck.* 2020;42(9):2397-2404. DOI: https://doi.org/10.1002/hed.26243

15. Liu H, Liu Z, Zhang Q, Guo W. Utilization of epinephrine-soaked gauzes to address bleeding from osteotomy sites in non-tourniquet total knee arthroplasty: a retrospective cohort study. *BMC Musculoskelet Disord.* 2020;21(1):578. DOI: https://doi.org/10.1186/s12891-020-03595-6

16. Awais M, Masood MH, Ahmed A, Irshad S, Aslam I, Gondal KM. Effect of electrocoagulation and direct pressure application on bleeding from liver bed during laparoscopic cholecystectomy. *J Coll Physicians Surg Pak.* 2023;33(7):754-759. DOI: https://doi.org/10.29271/jcpsp.2023.07.754

17. Arija D, Shah SMI, Rafiq S, Ahmed N, Memon AS, Naseer N. Comparative analysis of direct pressure and electrocauterization techniques for hemorrhage control in the liver bed during laparoscopic cholecystectomy. *Int J Pharm Res Technol.* 2025;15(1):1071-1076.