Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis

• Secure the appendix stump in laparoscopic appendectomy.
• Similar complication rates.
• Metallic endo-clip costs higher than extra-corporeal knotting.
• Shorter operative times.

BackgroundAn adequate closure of the appendiceal stump is vital to minimize intra-abdominal and surgical site infections. There are various techniques for the closure of base of appendix while performing a laparoscopic appendectomy like endoloops, knotting, clips and staplers.ObjectiveTo compare the extracorporeal knot-tying suture with metallic endoclips in laparoscopic appendiceal stump closure in terms of complications, operative time, hospital stay and cost.MethodologyThis study was conducted as a single-blinded randomized controlled trial. Patients undergoing laparoscopic appendicectomies in three tertiary care hospitals of Peshawar, i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex from June 1, 2013 to June 1, 2014 were included in the study and randomized into two groups – extra-corporeal knotting group and the metallic endoclip group. Data on demographics, complications, operative time, hospital stay and cost for the two techniques were collected and analyzed. Statistics analyses were done with IBM SPSS v19 (IBM Corp., Armonk, NY, USA). T-test was use for comparison of continuous data; Chi-square test was used for comparison of categorical data. P < 0.05 was considered statistically significant.ResultsA total of 68 patients were enrolled in the study and randomized into two groups: metallic endoclip group n = 32 (47.1%), extracorporeal knot group n = 36 (52.9%). The two groups didn't significantly differ in age (P = 0.9). There were no statistically significant differences between the two groups in terms of complication rates (P > 0.05) and hospital stay (P > 0.05). The mean operative time for the endoclip group was shorter (mean 42.1 ± 7.4 min) as compared to the extracorporeal knot group (mean 48.3 ± 8.4 min) (P = 0.002). The cost of endoclip group was higher (800PKR = 8.10US$) as compared to the extracorporeal knot group (220PKR = 2.23US$).ConclusionThe use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it's a useful alternative to the extracorporeal knotting especially for learners.