Clip-Less Extracorporeal Knot Versus Clip Ligation Laparoscopic Cholecystectomy—A Randomized Controlled Trial

Introduction: Laparoscopic cholecystectomy is bread-and-butter not only for hepatobiliary surgeons, but also for general surgeons. To secure cystic duct clips are used routinely. Suture ligation of cystic duct and its various methods have been also described. But there is insufficient studies comparing the various methods prospectively. Objectives: To compare feasibility, operative time (incision to closer), postoperative pain, operative cost, complications of procedure, and cosmetic outcome between patients treated by laparoscopic cholecystectomy with either extracorporeal knotting or clip ligation of cystic duct. Methodology: This was a randomized controlled trial conducted from July 2021 to June 2024. Study patients selected for laparoscopic cholecystectomy were assigned by randomization in to two groups: patients who were treated by extracorporeal knotting through 5 mm epigastric port (study group), and in control group where clips were used. Results: Five hundred and six cases were subjected to laparoscopic cholecystectomy during study period. In study group, operation was significantly prolonged (68.25 Vs. 59.37minutes). Ligation of cystic duct by using suture is cost effective than clips (300 vs. 500 BDT). Both groups had no significant complications. Clip less study group shows cosmetic superiority than clipped control group. Conclusion: Extracorporeal ligation of cystic duct is safe, economic and cosmetically better in comparison to clip ligation for laparoscopic cholecystectomy. The limitation is operative time.