Impact of metal vs non-absorbable, polymer clips during laparoscopic cholecystectomy

Titanium metal clips have classically been used to occlude the cystic artery and duct during laparoscopic cholecystectomy (LC). Non-absorbable, polymer clips are an alternative with a locking feature. There is limited research evaluating the adoption, safety, and cost of these clips during cholecystectomy.

A retrospective review was conducted on patients undergoing elective LC from 2017 to 2019. The cohort was divided based on the use of metal or polymer clips. The primary outcome was 30-day emergency department (ED) visit rate. Secondary outcomes included readmission and complications. Surgeon utilization and cost comparison were assessed. Chi square, Wilcoxon rank-sum, and multivariable logistic regression was performed.

1244 patients underwent LC by 38 surgeons, of which 934 (75.1%) utilized metal clips. Thirty-day ED presentation was 8.5%, with a higher rate for the polymer clip group (12.4% vs 7.2%, p = 0.005); 79% of presentations were related to the operation. On adjusted analysis, ED visits were associated with hospital facility and insurance payor. Thirty-day readmission rate was comparable for polymer and metal clips (4.9% vs 3.2%, p = 0.18, respectively). Most surgeons used metal clips (58%) and there was no impact based on fellowship training. Those who preferentially utilized polymer clips had more recently graduated from medical school (p = 0.02) and were more likely to perform intraoperative cholangiograms (p < 0.001). The device cost difference favored polymer clips by $75 per case.

Polymer clips are a safe alternative to metal clips, with a similarly low complication profile. Despite an increase in 30-day ED visit rate in the polymer group, adjusted analysis demonstrated an association with hospital facility and insurance type, and not clip type. Given LC is one of the most commonly performed operations worldwide, the benefit of locking polymer clips should be incorporated into intraoperative decision making.