COMPARISON BETWEEN METAL CLIP APPLICATION AND SUTURE LIGATION OF CYSTIC DUCT IN LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Acute cholecystitis frequently requires laparoscopic cholecystectomy. Metal clips reduce operative time but may increase risks of bile leak or clip migration, whereas suture ligation offers greater safety. Conflicting evidence necessitated this comparative study.

Objective: To compare metal clip application and suture ligation of cystic duct in laparoscopic cholecystectomy in terms of frequency of bile leak and mean operation time. 

Duration: Three months w.e.f.  03-04-2025 to 03-07-2025

Methodology: After ethical approval, 120 patients undergoing laparoscopic cholecystectomy for acute cholecystitis were enrolled and randomly assigned to metal clip or suture ligation groups. Standard four-port LC was performed under general anaesthesia, with cystic duct and artery secured by clips or chromic catgut ligatures. Procedures were conducted by a single consultant to ensure consistency and minimize bias.

Results: A total of 120 patients were included, with a mean age of 46.04±11.30 years; 65% were above 40 years. Females comprised 60.8%, and the mean BMI was 27.52±3.47 kg/m², with 75.8% overweight or obese. Operative time was 48.28±8.35 min (metal clips) and 54.53±9.65 min (suture ligation, p=0.000). Bile leak occurred in 6 patients (10.0%) with metal clips and none with suture ligation (p=0.027). Clip migration was 1.7% and 0% respectively (p=1.000). 

Conclusion: The study concludes that suture ligation of the cystic duct reduces bile leak and clip migration, while metal clip application shortens operative time. Overall, suture ligation is recommended as the safer technique in laparoscopic cholecystectomy.