Clipless Versus Clip-Based Cystic Duct Closure in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Secure cystic duct and artery control is vital in laparoscopic cholecystectomy.
• Metallic clips, the standard, raise concerns about migration, bile leaks, and long-term safety.
• Alternative techniques include polymer clips, endoloops, sutures, and energy devices.

Purpose of the Study:

• To systematically review and meta-analyze alternative cystic duct closure methods.
• To compare the safety and efficacy of polymer clips and energy devices against metallic clips.

Main Methods:

• Systematic review and meta-analysis following PRISMA 2020 guidelines.
• Searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library (search completed May 2024).
• Included 14 comparative studies evaluating outcomes like bile leak, bleeding, operative time, and complications.

Main Results:

• Polymer locking clips showed 0% bile leak and secured wide cystic ducts.
• Ultrasonic scalpel and advanced bipolar energy devices significantly reduced operative times versus metallic clips.
• Device complications included metallic clip migration and suture knot loosening.

Conclusions:

• Polymer clips and energy-based devices are safe and effective alternatives to metallic clips.
• These alternatives offer comparable safety, reduced operative time, and avoid long-term clip issues.
• Further large multicenter randomized trials are needed to confirm long-term outcomes and cost-effectiveness.