Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan

  • Dr Abdul Manan Nishtar Medical University
  • Dr Ashar Ahmad Khan Assistant prof
  • Irfan Ahmad
  • Dr Muhammad Usman
  • Tariq Jamil
  • Dr Muhammad Afzal sajid



To compare the efficacy of clipless cholecystectomy using harmonic scalpel and clipped conventional laparoscopic cholecystectomy.

Study design:

A randomized control trial.

Place and duration of study:

Department of general surgery at Nishtar Hospital Multan, from October 1st 2019 to March 31st 2020.


Total 188 patients of gallstone related cholecystitis were enrolled in the study and were selected using non-probability consecutive sampling technique. All the patients were randomly divided into two equal groups. One group was designated for clipless and the other for conventional clipped laparoscopic cholecystectomy. Age, gender, duration of cholecystitis, duration of Procedure, hospital stay, usefulness in difficult procedures and biliary leakage were recorded for all the patients. Data was entered in SPSS version 23 and analyzed.


Operation time was 28.35±7.92 minutes and 21.15±4.47 minutes in clipped and unclipped surgery, respectively (p<0.001). Hospital stay was 2.37±0.60 days in clipped surgery group and 1.71±0.74 days in clipless surgery group (p<0.001). Biliary leakage was reported in 2(2.1 %) patients of the clipped group and 1(1.1%) patients of the unclipped group (p = 0.561). Usefulness of the procedure in difficult cases was documented in 0 (0.0%) of the clipped procedures and in 8 (8.5%) of the clipless procedures (p=0.004).


As witnessed from this study, it can be concluded that clipless surgery is a better option as compared to the clipped conventional laparoscopic Cholecystectomy as former is associated with shorter operation time, shorter hospital stay and better usefulness in difficult cases.

Original Articles