ReviewCureus2025
Clipless Versus Clip-Based Cystic Duct Closure in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Secure control of the cystic duct and artery is a critical step in laparoscopic cholecystectomy. Although metallic clips remain the standard method, concerns regarding clip migration, bile leak, and long-term safety have led to the use of alternative techniques such as polymer locking clips, endoloops, absorbable clips, sutures, and energy-based devices, including the ultrasonic scalpel and advanced bipolar energy devices. This systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was performed, with the final search completed in May 2024. Studies comparing at least two cystic duct closure methods and reporting outcomes such as bile leak, bleeding, operative duration, conversion to open surgery, hospital stay, or device-related complications were included. Risk of bias was evaluated using AMSTAR (A Measurement Tool to Assess systematic Reviews) for randomized trials and ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) for observational studies. Random-effects models were used to pool relative risks (RRs) and mean differences (MDs). A total of 14 comparative studies (with supportive case reports) met the inclusion criteria. Polymer locking clips demonstrated 0% bile leak and provided secure closure even in wide cystic ducts. Ultrasonic scalpel and advanced bipolar energy devices were associated with significantly shorter operative times compared with metallic clips. Conversion rates remained low across all techniques, with a nonsignificant trend favoring energy-based devices. Device-specific complications included metallic clip migration and occasional knot loosening with suture ligation. Overall, polymer clips and energy-based devices appear to be safe and effective alternatives to metallic clips, offering comparable safety profiles, reduced operative time, and avoidance of long-term clip-related complications. Larger multicenter randomized controlled trials are needed to validate long-term outcomes and cost-effectiveness.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.