Bartholomew A J, Jing C, Economopoulos K P, Sizemore A, Lim J, Record S, Greene S, Ladowski J M, Howell T C, Gordee A, Kuchibhtala M, Yoo J, Jain-Spangler K, Michaels A D, Fong P A, Greenberg J A, Seymour K A
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Duke University School of Medicine, Durham, NC, USA.
Surg Endosc. 2025 Apr;39(4):2288-2295. doi: 10.1007/s00464-025-11559-x. Epub 2025 Feb 12.
Titanium 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.
A 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.
1244 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.
Polymer 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.
在腹腔镜胆囊切除术（LC）中，传统上使用钛金属夹来夹闭胆囊动脉和胆囊管。不可吸收的聚合物夹是一种具有锁定功能的替代选择。关于这些夹子在胆囊切除术中的应用、安全性和成本的研究有限。
对2017年至2019年接受择期LC的患者进行回顾性研究。根据使用金属夹或聚合物夹将队列分组。主要结局是30天急诊科（ED）就诊率。次要结局包括再入院和并发症。评估了外科医生的使用情况和成本比较。进行了卡方检验、Wilcoxon秩和检验和多变量逻辑回归分析。
38名外科医生为1244例患者实施了LC，其中934例（75.1%）使用了金属夹。30天内急诊就诊率为8.5%，聚合物夹组的就诊率更高（12.4%对7.2%，p = 0.005）；79%的就诊与手术有关。经调整分析，急诊就诊与医院设施和保险支付方有关。聚合物夹和金属夹的30天再入院率相当（分别为4.9%对3.2%，p = 0.18）。大多数外科医生使用金属夹（58%），并且基于专科培训没有影响。那些优先使用聚合物夹的医生毕业时间更近（p = 0.02），并且更有可能进行术中胆管造影（p < 0.001）。设备成本差异显示聚合物夹每例节省75美元。
聚合物夹是金属夹的一种安全替代物，并发症发生率同样较低。尽管聚合物夹组30天急诊就诊率有所增加，但经调整分析显示与医院设施和保险类型有关，而与夹子类型无关。鉴于LC是全球最常见的手术之一，锁定聚合物夹的益处应纳入术中决策。
