Abstract
Laparoscopic cholecystectomy is a widely performed procedure, with securing the cystic duct being a critical step to prevent bile leakage. Traditional metal clips are commonly used, but alternative methods, such as non-absorbable polymer clips, absorbable clips, sutures, and ultrasonic shears, are also utilized. This systematic review and meta-analysis evaluates the safety and efficacy of various cystic duct securing techniques. Following PRISMA guidelines, a comprehensive search was conducted across the EMBASE, MEDLINE, and Cochrane databases without date restrictions. Eligible studies compared different techniques for cystic duct closure in laparoscopic cholecystectomy, focusing on bile leakage as a primary outcome. Data extraction and synthesis were performed using a binary random-effects model. Meta-analyses were conducted for absorbable clips, sutures, hem-o-lok clips, and ultrasonic devices compared to standard metal clips. A total of 26 studies met the inclusion criteria. Absorbable polymer clips demonstrated a statistically significant reduction in postoperative bile leakage compared to metal clips (OR 0.159; 95% CI 0.031-0.818; P=0.028). In contrast, no significant differences were observed when comparing metal clips with suture ties (OR 0.459, 95% CI 0.139-1.522, P=0.203), non-absorbable clips (OR 0.166, 95% CI 0.025-1.109, P=0.064), or the clipless technique with a harmonic device (OR 1.332, 95% CI 0.425-4.169, P=0.623).