Surgical clips used in gallbladder removal, known as cholecystectomy, are small, non-absorbable medical devices implanted to seal the structures that connected the gallbladder. These instruments are a standard feature in modern laparoscopic surgery, providing a swift and reliable method for securing internal tissues. For many patients, the presence of these permanent components prompts questions about their physical characteristics and long-term implications.
Size, Shape, and Material Composition
Surgical clips come in two primary forms: metallic and polymeric, each with a distinct appearance and composition. The most common metallic clips are made from medical-grade titanium, a highly biocompatible and inert material that the body does not reject. When closed, these metallic clips are generally quite small, often measuring between 5 to 10 millimeters in length.
Metallic clips are typically V-shaped or chevron-shaped when open, and they are mechanically crimped onto the tissue to create a secure seal. Titanium is favored because it is non-ferromagnetic, meaning it does not interact with magnets and is safe inside the body. Non-absorbable polymeric clips, like the Hem-o-lok system, are another common option, made from a plastic-like substance.
These polymer clips are designed with a locking mechanism and come in a range of sizes, such as Medium-Large or Extra-Large, capable of ligating structures up to 16 millimeters in diameter. Unlike the malleable titanium clips, the polymer versions are rigid and colored, often green or purple, to help the surgeon distinguish between different sizes. Both titanium and polymer clips are specifically engineered to be chemically stable within the body’s environment.
Why Surgical Clips Are Used
The primary function of these clips is to mechanically occlude, or close off, the two main structures connecting the gallbladder to the rest of the body before the organ is removed. During a cholecystectomy, the cystic duct and the cystic artery must be securely sealed to prevent complications. The cystic duct carries bile into the main bile duct system, and the cystic artery provides the organ’s blood supply.
Clips are strategically placed across the cystic artery to achieve immediate hemostasis (cessation of blood flow), preventing internal bleeding. Simultaneously, clips are placed on the cystic duct to ensure a tight seal that prevents bile from leaking into the abdominal cavity. Secure closure of the duct is paramount, as bile leakage can lead to infection and peritonitis.
Using a clip applicator to rapidly deploy and crimp these devices is a technically efficient method within the limited space of laparoscopic surgery. Surgeons often place multiple clips on each structure—usually three—before cutting the tissue between them. This technique provides a fast, reliable, and reproducible means of ligation compared to the time-consuming process of suturing and tying knots in a minimally invasive setting.
Clips: Permanence and Visibility in Imaging
For the vast majority of patients, the surgical clips placed during gallbladder removal are permanent implants intended to remain in the body indefinitely. They are designed to stay securely fixed to the tissue where they were placed, and the body eventually forms scar tissue around them, stabilizing their position. This permanence is a necessary feature to ensure the long-term integrity of the sealed cystic duct and artery.
Metallic clips made of titanium are radiopaque, meaning they absorb X-rays and appear clearly on diagnostic imaging. On an X-ray or a computed tomography (CT) scan, these tiny components show up as distinct, bright white, V-shaped or chevron-shaped spots in the area of the upper abdomen where the gallbladder once was. Their presence is a normal and expected finding following the operation.
Because titanium is non-ferromagnetic, metallic clips are considered safe for magnetic resonance imaging (MRI) procedures. They do not pose a risk of being pulled or heated by the magnetic field, though they may cause a minor artifact or distortion in the surrounding image. Conversely, polymeric clips are radiolucent, meaning they do not show up on X-rays or CT scans, and they cause virtually no interference with future imaging studies.