ArticleSurgical endoscopy2025
Impact of metal vs non-absorbable, polymer clips during laparoscopic cholecystectomy.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Changes in ultrasonic scalpel performance and characterization following gastric cancer surgery.Surgical endoscopy · 2026Article
- Bile leak after elective laparoscopic cholecystectomy: association with transcystic instrumentation and cystic duct closure method.Surgical endoscopy · 2026Article
- Titanium Allergy: A Case of Foreign Body Reaction Following Laparoscopic Cholecystectomy.Cureus · 2026Article
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Authors and funding
17 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundTitanium 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.
methodsA 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.
results1244 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.
conclusionPolymer 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.
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