Publication:

Comparison of loop ligation and clip ligation of the cystic duct during laparoscopic cholecystectomy: a prospective study

Background Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and cholecystitis. Cystic duct stump leakage remains an important and potentially preventable cause of postoperative bile leak. This study compared loop ligature closure and clip closure of the cystic duct with respect to postoperative bile leak following laparoscopic cholecystectomy.

Methods A prospective comparative study was conducted at Stanley Medical College Hospital, Chennai, between August 2023 and September 2025. One hundred patients with symptomatic cholelithiasis or acute cholecystitis undergoing elective laparoscopic cholecystectomy were enrolled. Patients were allocated to either Group A (loop ligature closure) or Group B (clip closure) of the cystic duct. Postoperative monitoring for bile leak was performed through clinical assessment and biochemical evaluation. Patients were followed up at 1 and 3 months.

Results Three patients required conversion to open cholecystectomy and were excluded from the analysis. Among the remaining 97 patients, bile leak occurred in 1 of 47 patients (2.1%) in the loop closure group and 2 of 49 patients (4.1%) in the clip closure group, with no statistically significant difference between the groups. Both techniques provided effective cystic duct occlusion. Loop ligature closure was associated with lower material cost compared with metallic clips. No late complications were observed during follow-up.

Conclusion Loop ligature closure and clip closure are both safe and effective methods for cystic duct occlusion during laparoscopic cholecystectomy. Loop ligature closure represents a practical and cost-effective alternative to metallic clips without increasing the risk of postoperative bile leak.