Clipless Versus Conventional Clip-Based Laparoscopic Cholecystectomy: A Prospective Comparative Study Of Operative Safety and Early Recovery Outcomes

Abstract

Background: Clipless laparoscopic cholecystectomy has emerged as a technically appealing alternative to conventional clip-based cystic pedicle control, but its practical value depends on operative efficiency, safety, postoperative pain, and return to routine activity.

Objective: To compare clipless and conventional laparoscopic cholecystectomy with respect to operative time, intra-operative blood loss, perioperative safety, postoperative pain, hospital stay, and early functional recovery.

Materials and Methods: This prospective comparative study was conducted from March 2025 to November 2026. Eighty patients undergoing laparoscopic cholecystectomy were analyzed, with 40 managed by the clipless technique and 40 by the conventional technique. Demographic profile, ASA grade, indication for surgery, prior abdominal surgery, operative duration, blood loss, intra-operative complications, bile duct injury, conversion to open surgery, 6-hour pain score, hospital stay, time to return to normal activity, Clavien-Dindo grade, and 30-day readmission were assessed. Continuous variables were compared using Welch independent-samples t-test, and categorical variables were assessed using chi-square or Fisher exact test as appropriate.

Results: The groups were comparable for age (48.08 ± 9.79 vs 50.15 ± 9.90 years; p=0.349), BMI (27.14 ± 2.92 vs 27.59 ± 2.80 kg/m2; p=0.487), sex distribution, ASA class, and operative indication. Clipless cholecystectomy was associated with shorter operative time (46.70 ± 6.46 vs 65.53 ± 6.11 minutes; p<0.001), lower blood loss (23.25 ± 9.81 vs 32.42 ± 12.93 mL; p=0.001), lower 6-hour VAS score (3.21 ± 0.61 vs 4.81 ± 0.61; p<0.001), shorter hospital stay (1.92 ± 0.46 vs 2.66 ± 0.44 days; p<0.001), and earlier return to normal activity (7.78 ± 2.25 vs 11.55 ± 2.26 days; p<0.001). No bile duct injury or conversion to open surgery occurred in either group. Postoperative complications were mild to moderate and did not differ significantly between groups (15.0% vs 22.5%; p=0.568).

Conclusion: In this cohort, clipless laparoscopic cholecystectomy demonstrated better operative efficiency and faster early recovery while maintaining a safety profile comparable to conventional clip-based surgery. The findings support clipless technique as a feasible option in appropriately selected patients, provided safe dissection principles are strictly followed.