1MS Gen Surgery Postgraduate, SRM Medical College Hospitals, Kattankulathur. Mail id: spkarthika97@gmail.com
2*MS Gen Surg, DMAS, FMAS. Ph no: 97908 28131. Mail: Lakshmar@srmist.edu.in (Corresponding Author)
3Associate Professor, MS Gen Surgery Postgraduate, SRM Medical College Hospitals, Kattankulathur. Email: Debaratd@srmist.edu.in
4Assistant Professor, MS Gen Surgery Postgraduate, SRM Medical College Hospitals, Kattankulathur. Mail: pravinda@srmist.edu.in
Background: Laparoscopic cholecystectomy has largely replaced open cholecystectomy due to reduced postoperative pain, shorter hospital stay, faster recovery, and improved cosmetic outcomes. Secure occlusion of the cystic duct is a critical step during the procedure. Titanium clips are widely used; however, complications such as clip slippage, migration, bile leakage, haemorrhage, and bile duct injury have been reported. Intracorporeal knotting using absorbable sutures (Vicryl) has emerged as a potential safe and cost-effective alternative.
Aim: To compare intracorporeal knotting with Vicryl versus titanium clips for cystic duct ligation in laparoscopic cholecystectomy with respect to safety, feasibility, cost-effectiveness, and postoperative outcomes.
Methods: This prospective randomized controlled study included patients undergoing elective and emergency laparoscopic cholecystectomy. Participants were randomly allocated into two groups: intracorporeal knotting (Vicryl) group and titanium clip group. Intraoperative parameters (operative time, haemorrhage, technical difficulty) and postoperative outcomes (bile leak, bile duct injury, stricture, clip migration, pain score, hospital stay, and recovery time) were compared between the two groups.
Results: Both groups were comparable in baseline demographic characteristics, comorbidities, and disease profile. Intracorporeal knotting was associated with a significantly lower incidence of intraoperative haemorrhage and fewer postoperative complications such as bile leak, stricture formation, and clip migration. Postoperative pain scores, recovery time, and duration of hospital stay were significantly lower in the knotting group. No cases of common bile duct injury were observed in either group. However, operative duration and surgeon-assessed technical difficulty were significantly higher in the intracorporeal knotting group. In emergency laparoscopic cholecystectomy, complication rates were higher in the clip group compared to the knotting group.
Conclusion: Intracorporeal knotting with Vicryl is a safe, effective, and economical alternative to titanium clip application for cystic duct ligation in laparoscopic cholecystectomy. Although technically more demanding and associated with longer operative time, it reduces postoperative complications and enhances recovery, particularly in difficult and emergency cases. With adequate surgical expertise, this technique can be incorporated into routine laparoscopic practice to improve patient outcomes.
Keywords: Laparoscopic cholecystectomy, intracorporeal knotting, titanium clips, cystic duct ligation, bile leak, postoperative complications
How to cite this article: Karthika SP, Lakshmana R, Das D, Dhas P. A Randomized Control Study of Intracorporeal Knotting with Vicryl versus Titanium Clips for Ligating Cystic Duct in Laparoscopic Cholecystectomy. Int J Drug Deliv Technol. 2026;16(13s): 749-756. DOI: 10.25258/ijddt.16.13s.81.
Source of support: Nil.
Conflict of interest: None