Background: The efficacy and applicability of an absorbable polydioxan
one (PDS) clip for cystic duct ligation were evaluated in 297 patients
undergoing laparoscopic cholecystectomy. Methods: The indications for
cholecystectomy were symptomatic gallstones (179 patients), acute cho
lecystitis (67), biliary pancreatitis (23), acute cholangitis (24), an
d gallbladder polyp (4). Results: Twenty-five patients required conver
sion to open surgery (8.4%). The conversion rate was 2.7% for uncompli
cated and 17.5% for complicated gallbladder diseases. Of the 272 patie
nts with laparoscopic cholecystectomy, the cystic ducts were successfu
lly ligated with PDS clips in 227 patients (83.5%). The success rate w
as higher in uncomplicated (163/178) than in complicated (64/94) gallb
ladder diseases (chi square 24.6, P < 0.001). There was no clip-relate
d complication on follow-up (range 0.4-39.2, median 17.5 months). In 4
5 patients, PDS clip failed. They were treated with endoloop (14 patie
nts), Roeder slip knot (13), metallic clips and endoloop (8), metallic
clips alone (6), and intracorporeal tie (4). Conclusions: The PDS cli
p is effective and applicable to the majority of patients. It should b
e attempted first because of the ease of application.