Intraoperative Complications of Cystic Duct Sealing: Titanium Clips versus LigaSure®
Keywords:
Titanium clips, laparoscopic cholecystectomy, intraoperative complications, cystic duct, LigaSure®.Abstract
Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis due to its clinical benefits and lower morbidity and mortality compared to open surgery. A critical step in the procedure is sealing the cystic duct, traditionally performed with titanium clips, although advanced energy devices such as LigaSure® have emerged as alternatives. The objective of this study was to analyze intraoperative complications according to the method of cystic duct sealing using titanium clips versus LigaSure® in patients undergoing elective laparoscopic cholecystectomy. An observational, analytical, retrospective, and cross-sectional study was conducted with 222 medical records, dividing patients into two equal groups. The mean age was 41.6 years, with a predominance of females (80.2%). Intraoperative complications occurred in 4% of cases, with no statistically significant association between the sealing method and their occurrence (p = 0.518). Both methods showed comparable safety profiles, although complications with clips were clinically more complex.
References
Álvarez Abad, I., Gutiérrez Grijalba, O., Sarriugarte Lasarte, A., & Calle Baraja, M. (2017). Migración de clip al colédoco tras colecistectomía laparoscópica. Cirugía Española, 95(2), 111. http://dx.doi.org/10.1016/j.ciresp.2016.02.005
Arezzo, A., Passera, R., Bullano, A., Mintz, Y., Kedar, A., Boni, L., Cassinotti, E., & Morino, M. (2022). Multi-port versus single-port cholecystectomy: Results of a systematic review and meta-analysis. Surgical Endoscopy, 36(2), 889–902. https://doi.org/10.1007/s00464-016-5298-7
Bencini, L., Boffi, B., Farsi, M., Sanchez, L. J., Scatizzi, M., & Moretti, R. (2003). Laparoscopic cholecystectomy: Retrospective comparative evaluation of titanium versus absorbable clips. Journal of Laparoendoscopic & Advanced Surgical Techniques, 13(2), 93–98. https://doi.org/10.1089/109264203764654713
Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., Bonjer, H. J., McDonald, M., Alseidi, A., Ujiki, M., & Fanelli, R. D. (2020). Safe cholecystectomy multi-society practice guideline and state of the art consensus conference. Annals of Surgery, 272(1), 3–23. https://doi.org/10.1097/SLA.0000000000003791
Chowbey, P., Lal, P., Sharma, A., & Khullar, R. (2018). Common laparoscopic procedures. Springer. https://doi.org/10.1007/978-81-322-1867-8
Devkaran, B., Attri, A., & Chandel, U. K. (2022). EP-190 Comparative study of single clip laparoscopic cholecystectomy (SCLC), two clips laparoscopic cholecystectomy (TCLC) and clipless laparoscopic cholecystectomy (CLLC) vs conventional laparoscopic cholecystectomy (CLC). British Journal of Surgery. https://doi.org/10.1093/bjs/znac245.047
Elghadban, H., Mahmoud, A., Negm, A., Dawoud, I. E. S., & Taki-Eldin, A. (2024). Evaluation of safety and feasibility of using LigaSure during clipless single-incision laparoscopic cholecystectomy: A prospective clinical study. Journal of Laparoendoscopic & Advanced Surgical Techniques. https://doi.org/10.1089/lap.2024.0157
Gustafsson, A., Enochsson, L., Tingstedt, B., & Olsson, G. (2022). Bile leakage and the number of metal clips on the cystic duct during laparoscopic cholecystectomy. Scandinavian Journal of Surgery, 111(2). https://doi.org/10.1177/14574969221102284
Hasan Chowdhury, M., Ullah, M. A., Rahman, M. Z., Rahman, S., Arefin, N., & Islam, M. A. (2023). A comparative study between metal clip application and suture ligation of cystic duct in laparoscopic cholecystectomy. Med Today, 35(1), 27–30. https://doi.org/10.3329/medtoday.v35i1.64935
Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J. F., Méndez-Sánchez, N., Portincasa, P., van Erpecum, K. J., & van Laarhoven, C. J. (2016). Gallstones. Nature Reviews Disease Primers. https://doi.org/10.1038/nrdp.2016.24
Lucocq, J., Radhakishnan, G., Scollay, J., & Patil, P. (2022). Morbidity following emergency and elective cholecystectomy: A retrospective comparative cohort study. Surgical Endoscopy, 36(11), 8451–8457. https://doi.org/10.1007/s00464-022-09103-2
Mohamed, I. A., Elewesy, E. A., & Saad, A. S. E. S. (2023). A comparative study between cystic duct clipping and ligation in laparoscopic cholecystectomy. Al-Azhar International Medical Journal, 4(3). https://aimj.researchcommons.org/journal/vol4/iss3/2
Ng, D. Y. L., Petrushnko, W., & Kelly, M. D. (2020). Clip as nidus for choledocholithiasis after cholecystectomy—Literature review. JSLS: Journal of the Society of Laparoscopic & Robotic Surgeons, 24(1). https://doi.org/10.4293/jsls.2019.00053
Oyola, A. M., Miller, J., Edgerton, C., Hope, W., et al. (2023). Polymer versus titanium clips in laparoscopic cholecystectomy. Surgical Technology International, 43. https://doi.org/10.52198/23.sti.43.gs1730
Schulze, S., Damgaard, B., Jorgensen, L. N., Larsen, S. S., & Kristiansen, V. B. (2010). Cystic duct closure by sealing with bipolar electrocoagulation. JSLS, 14(1), 20–22. https://doi.org/10.4293/108680810X12674612014347
Singh, R., Arumugam, P., Mathur, K., & Deo, A. (2024). Post-cholecystectomy clip migration: A case report. Cureus, 16(4). https://doi.org/10.7759/cureus.58580
Wakabayashi, G., Iwashita, Y., Hibi, T., Takada, T., Strasberg, S. M., Asbun, H. J., Endo, I., Umezawa, A., Asai, K., Suzuki, K., Mori, Y., & Yamashita, Y. (2018). Tokyo Guidelines 2018: Surgical management of acute cholecystitis and safe laparoscopic cholecystectomy. Journal of Hepato-Biliary-Pancreatic Sciences, 27(1), 55–72. https://doi.org/10.1002/jhbp.517
Yang, C. P., Cao, J. L., Yang, R. R., Guo, H. R., Li, Z. H., Guo, H. Y., et al. (2014). Efficacy of electrocoagulation in sealing the cystic artery and cystic duct occluded with only one absorbable clip during laparoscopic cholecystectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques, 24(2), 72–76. https://doi.org/10.1089/lap.2013.0193
Published
Issue
Section
License
Copyright (c) 2026 Jorge Javier Vera Macías, Melissa Katherine Ponce Ponce, Jorge Octavio Vera Macías, Paola Elizabeth Ruiz Guillén
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
CC Reconocimiento-NoComercial-SinObrasDerivadas 4.0
.jpg)
![](https://clustrmaps.com/site/1bhn8" title="Visit tracker"><img src="//www.clustrmaps.com/map_v2.png?d=2WTJsN7QOuRFRD2DOJOZtvZ6v94bxB6RU96I-iXx-_s&cl=ffffff"></a>)
