{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:08:24Z","timestamp":1777921704216,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = \u221214.32 [\u221219.37, \u22129.28]), SL MD = \u221220.16 (\u221210.84, \u221229.47), and AC MD = \u221218.32 (\u22121.25, \u221235.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 41.8, and SL had the highest probability\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lap.2024.0295","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T11:32:28Z","timestamp":1732793548000},"page":"31-35","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative Effectiveness of Different Cystic Duct Ligation Techniques in Laparoscopic Cholecystectomy: A Systematic Review and Network Meta-Analysis"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-4874","authenticated-orcid":false,"given":"Christos","family":"Athanasiou","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary and Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Radwan","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya","family":"Kanwar","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery University Hospitals Plymouth NHS Trust, Plymouth, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasilis","family":"Kosmoliaptsis","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK."},{"name":"University of Cambridge School of Clinical Medicine, Cambridge, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somaiah","family":"Aroori","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery University Hospitals Plymouth NHS Trust, Plymouth, UK."},{"name":"Peninsula Medical School, University of Plymouth, Plymouth, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-005-0051-8"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1615\/JLongTermEffMedImplants.v15.i3.90"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5974-2"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00725942"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/136518201317077189"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v10.i6.57"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2021.0264"},{"key":"e_1_3_5_9_2","first-page":"35","article-title":"Laparoscopic suturing versus clip application in cholecystectomy: Tips and strategies for improving efficiency and safety","volume":"48","author":"Bali S","year":"2018","unstructured":"Bali S, , Singal R. 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