A Prospective Study Comparing Appendiceal Stump Closure Techniques with Liga Clips v/s Hem-o-Lok in Laparoscopic Appendectomy: Our Experience at a Single Institute

Abstract

Purpose: Closure of appendiceal stump (CAS) is one of the most crucial steps in laparoscopic appendectomy (LA) because inappropriate closure of stump may lead to stump leak further causing life-threatening complications like enterocutaneous fistulas, postoperative peritonitis, and sepsis. Recent studies have established the use of endoclips to be simpler and quicker as special laparoscopic skills are not required and hence seamlessly adapted. This study further aimed to compare the results of application endoclips like Liga Clips and Hem-o-Lok for CAS in LA in cases of Appendicitis without complications. Methods: It is a prospective study with sixty patients diagnosed with appendicitis without complications and planned for LA in a single institute. They were randomly divided into two groups, A and B, of 30 each using the sequentially numbered opaque sealed envelope (SNOSE) method. Liga Clips were used for CAS in group A and Hem-o-Lok in group B. Operative time and intraoperative and postoperative events were recorded. Results: The mean operative time (time from skeletonization of appendix to retrieval of the appendix) in group A was noted to be 376.03 s (6.27 min) and that in group B was noted to be 345.50 s (5.75 min) (p = 0.2873). No patient developed stump leak or intra-abdominal abscess or had to undergo reoperation in either of the groups. Conclusion: In conclusion, the use of both endoclips like Liga Clips and Hem-o-Lok for closure of appendiceal stump in laparoscopic appendectomy is a quicker, safe, secure, and feasible technique in cases of appendicitis without increased risk of complications. In our experience, it is suggested that Hem-o-Lok is more efficient in securing the appendiceal stump due to its lock engagement system giving a sense of security and ease of application.